Provider Demographics
NPI:1730306069
Name:MILLER, KATHRYN POFFENBARGER
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:POFFENBARGER
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:POFFENBARGER
Other - Last Name:COLVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:611 S 13TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4054
Mailing Address - Country:US
Mailing Address - Phone:772-464-5262
Mailing Address - Fax:
Practice Address - Street 1:7815 LOCUST PL
Practice Address - Street 2:
Practice Address - City:PORT TOBACCO
Practice Address - State:MD
Practice Address - Zip Code:20677-2002
Practice Address - Country:US
Practice Address - Phone:301-392-3908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03324235Z00000X
FL17662235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist