Provider Demographics
NPI:1265984025
Name:MILLS, OWEN HUNTER
Entity type:Individual
Prefix:
First Name:OWEN
Middle Name:HUNTER
Last Name:MILLS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17697 S DARRINS WAY
Mailing Address - Street 2:
Mailing Address - City:KINROSS
Mailing Address - State:MI
Mailing Address - Zip Code:49752-9179
Mailing Address - Country:US
Mailing Address - Phone:906-630-0196
Mailing Address - Fax:
Practice Address - Street 1:17697 S DARRINS WAY
Practice Address - Street 2:
Practice Address - City:KINROSS
Practice Address - State:MI
Practice Address - Zip Code:49752-9179
Practice Address - Country:US
Practice Address - Phone:906-630-0196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer