Provider Demographics
NPI:1669716759
Name:MILNE, STORMIE LEIGH
Entity type:Individual
Prefix:
First Name:STORMIE
Middle Name:LEIGH
Last Name:MILNE
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 1:1405 N 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-3330
Mailing Address - Country:US
Mailing Address - Phone:580-745-2000
Mailing Address - Fax:
Practice Address - Street 1:1405 N 4TH AVE
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-3330
Practice Address - Country:US
Practice Address - Phone:580-745-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255R0406XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistRehabilitation, Blind
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst