Provider Demographics
NPI:1700116118
Name:MILLER, MARY T (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:T
Last Name:MILLER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1592 INDIAN PONY CIR
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-4238
Mailing Address - Country:US
Mailing Address - Phone:310-474-4545
Mailing Address - Fax:310-862-4778
Practice Address - Street 1:26560 AGOURA RD STE 110B
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-3530
Practice Address - Country:US
Practice Address - Phone:310-474-4545
Practice Address - Fax:310-862-4778
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-07
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA182225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist