Provider Demographics
NPI:1851837322
Name:MILLER, CRYSTAL MARIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16705 PARKS ROAD
Mailing Address - Street 2:
Mailing Address - City:CANNELTON
Mailing Address - State:IN
Mailing Address - Zip Code:47520-8429
Mailing Address - Country:US
Mailing Address - Phone:812-881-0338
Mailing Address - Fax:
Practice Address - Street 1:11492 SUNFLOWER ROAD
Practice Address - Street 2:
Practice Address - City:TELL CITY
Practice Address - State:IN
Practice Address - Zip Code:47586
Practice Address - Country:US
Practice Address - Phone:812-881-0338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-09
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31006223A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist