Provider Demographics
NPI:1922334069
Name:MILLER, CARLA S (L M T)
Entity Type:Individual
Prefix:MS
First Name:CARLA
Middle Name:S
Last Name:MILLER
Suffix:
Gender:F
Credentials:L M T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10715 OLD STATE LINE RD
Mailing Address - Street 2:
Mailing Address - City:SWANTON
Mailing Address - State:OH
Mailing Address - Zip Code:43558-9694
Mailing Address - Country:US
Mailing Address - Phone:419-205-1226
Mailing Address - Fax:
Practice Address - Street 1:839 S MCCORD RD
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-8746
Practice Address - Country:US
Practice Address - Phone:419-205-1226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-25
Last Update Date:2009-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33 014953225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist