Provider Demographics
NPI:1801211735
Name:MILLER, PATRICIA (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 HUMPHREY LN
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-2215
Mailing Address - Country:US
Mailing Address - Phone:413-733-1036
Mailing Address - Fax:
Practice Address - Street 1:111 HUMPHREY LN
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-2215
Practice Address - Country:US
Practice Address - Phone:413-733-1036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-01
Last Update Date:2014-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1462224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant