Provider Demographics
NPI:1851372999
Name:MILLER, LOTTIE ANNE (SP)
Entity Type:Individual
Prefix:
First Name:LOTTIE
Middle Name:ANNE
Last Name:MILLER
Suffix:
Gender:F
Credentials:SP
Other - Prefix:
Other - First Name:LOTTIE
Other - Middle Name:ANNE
Other - Last Name:DUNBAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MACCC SLP
Mailing Address - Street 1:70 QUINCY AVE
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-6714
Mailing Address - Country:US
Mailing Address - Phone:617-786-8811
Mailing Address - Fax:617-786-8877
Practice Address - Street 1:70 QUINCY AVE
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-6714
Practice Address - Country:US
Practice Address - Phone:617-786-8811
Practice Address - Fax:617-786-8877
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5563235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA226525Medicare ID - Type Unspecified