Provider Demographics
NPI:1295259471
Name:MILLER, CHRISTINE PETRAS
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:PETRAS
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHRISTINEQ
Other - Middle Name:NICOLE
Other - Last Name:PETRAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:79170 PLUMMERS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097-2678
Mailing Address - Country:US
Mailing Address - Phone:706-834-6139
Mailing Address - Fax:
Practice Address - Street 1:79170 PLUMMERS CREEK DR
Practice Address - Street 2:
Practice Address - City:YULEE
Practice Address - State:FL
Practice Address - Zip Code:32097-2678
Practice Address - Country:US
Practice Address - Phone:706-834-6139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-31
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist