Provider Demographics
NPI:1851634760
Name:MILLER, MICHELLE SARA (OT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:SARA
Last Name:MILLER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4990 BOILING BROOK PKWY
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2300
Mailing Address - Country:US
Mailing Address - Phone:301-770-2710
Mailing Address - Fax:301-668-7008
Practice Address - Street 1:4990 BOILING BROOK PKWY
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-2300
Practice Address - Country:US
Practice Address - Phone:301-770-2710
Practice Address - Fax:301-668-7008
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD060301225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics