Provider Demographics
NPI:1770819898
Name:MILLER, KENDRA MICHELLE
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:MICHELLE
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 NW 66TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-8256
Mailing Address - Country:US
Mailing Address - Phone:405-840-1957
Mailing Address - Fax:405-840-1052
Practice Address - Street 1:200 NW 66TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-8256
Practice Address - Country:US
Practice Address - Phone:405-840-1957
Practice Address - Fax:405-840-1052
Is Sole Proprietor?:No
Enumeration Date:2009-10-23
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4233225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist