Provider Demographics
NPI:1245893957
Name:MILER-LYLES, REBEKAH (COTA/L)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:MILER-LYLES
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:553 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:WOOD RIVER
Mailing Address - State:IL
Mailing Address - Zip Code:62095-1752
Mailing Address - Country:US
Mailing Address - Phone:618-419-5516
Mailing Address - Fax:
Practice Address - Street 1:553 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:WOOD RIVER
Practice Address - State:IL
Practice Address - Zip Code:62095-1752
Practice Address - Country:US
Practice Address - Phone:618-419-5516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant