Provider Demographics
NPI:1851504286
Name:MILLER, ELSIE PIERCE (COTAL)
Entity Type:Individual
Prefix:MRS
First Name:ELSIE
Middle Name:PIERCE
Last Name:MILLER
Suffix:
Gender:F
Credentials:COTAL
Other - Prefix:MS
Other - First Name:ELSIE
Other - Middle Name:PIERCE
Other - Last Name:RUIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:402 MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-3854
Mailing Address - Country:US
Mailing Address - Phone:863-421-7209
Mailing Address - Fax:
Practice Address - Street 1:410 S 11TH ST
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33853-4203
Practice Address - Country:US
Practice Address - Phone:863-679-6841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA9861224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant