Provider Demographics
NPI:1013468479
Name:MILLER, SALLY ANN (MED, LAT, ATC)
Entity type:Individual
Prefix:MISS
First Name:SALLY
Middle Name:ANN
Last Name:MILLER
Suffix:
Gender:F
Credentials:MED, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 W 24TH AVE
Mailing Address - Street 2:APT 6A
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-5740
Mailing Address - Country:US
Mailing Address - Phone:304-282-3606
Mailing Address - Fax:
Practice Address - Street 1:1921 W 24TH AVENUE
Practice Address - Street 2:APT 6A
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-9400
Practice Address - Country:US
Practice Address - Phone:304-282-3606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24-009992255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer