Provider Demographics
NPI:1942630892
Name:MILEY, JENA
Entity Type:Individual
Prefix:
First Name:JENA
Middle Name:
Last Name:MILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-2024
Mailing Address - Country:US
Mailing Address - Phone:740-376-1084
Mailing Address - Fax:740-373-3915
Practice Address - Street 1:400 N 7TH ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-2024
Practice Address - Country:US
Practice Address - Phone:740-376-1084
Practice Address - Fax:740-373-3915
Is Sole Proprietor?:No
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH008314225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist