Provider Demographics
NPI:1972794139
Name:SAN MIGUEL, VIRGINIA H (OTR)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:H
Last Name:SAN MIGUEL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MRS
Other - First Name:GINI
Other - Middle Name:H
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:8718 W DEER VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-2453
Mailing Address - Country:US
Mailing Address - Phone:480-892-9777
Mailing Address - Fax:480-635-0222
Practice Address - Street 1:8718 W DEER VALLEY RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2453
Practice Address - Country:US
Practice Address - Phone:480-892-9777
Practice Address - Fax:480-635-0222
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2287225XP0200X
COAA495747225X00000X
NM2882225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics