Provider Demographics
NPI:1891841698
Name:MILLER, SUSAN KAE (OTR)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:KAE
Last Name:MILLER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 BARLOW AVE.
Mailing Address - Street 2:SUITE 11
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686
Mailing Address - Country:US
Mailing Address - Phone:231-941-3100
Mailing Address - Fax:231-922-0382
Practice Address - Street 1:1650 BARLOW AVE.
Practice Address - Street 2:SUITE 11
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686
Practice Address - Country:US
Practice Address - Phone:231-941-3100
Practice Address - Fax:231-922-0382
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201001217225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist