Provider Demographics
NPI:1013052752
Name:MILLER, PEGGY SUE
Entity Type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:SUE
Last Name:MILLER
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 1:1343 VILLAGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ST JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506
Mailing Address - Country:US
Mailing Address - Phone:816-232-2878
Mailing Address - Fax:816-232-5056
Practice Address - Street 1:1343 VILLAGE DRIVE
Practice Address - Street 2:
Practice Address - City:ST JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506
Practice Address - Country:US
Practice Address - Phone:816-232-2878
Practice Address - Fax:816-232-5056
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004912225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO23185031OtherBCBS