Provider Demographics
NPI:1841209897
Name:MILLETT, DAISY CLANTON (LMT, LMBT)
Entity Type:Individual
Prefix:
First Name:DAISY
Middle Name:CLANTON
Last Name:MILLETT
Suffix:
Gender:F
Credentials:LMT, LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 411
Mailing Address - Street 2:
Mailing Address - City:PAISLEY
Mailing Address - State:FL
Mailing Address - Zip Code:32767-0411
Mailing Address - Country:US
Mailing Address - Phone:352-669-8978
Mailing Address - Fax:352-669-8978
Practice Address - Street 1:527 UMATILLA BLVD
Practice Address - Street 2:
Practice Address - City:UMATILLA
Practice Address - State:FL
Practice Address - Zip Code:32784-9091
Practice Address - Country:US
Practice Address - Phone:352-669-8978
Practice Address - Fax:352-669-8978
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC239225700000X
FLMA25673225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist