Provider Demographics
NPI:1740060052
Name:MCMILLAN, BETH M (MOT/L)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:M
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:MOT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11301 BROOMFIELD LN APT 302
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-5028
Mailing Address - Country:US
Mailing Address - Phone:978-766-0573
Mailing Address - Fax:
Practice Address - Street 1:11301 BROOMFIELD LN APT 302
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80021-5028
Practice Address - Country:US
Practice Address - Phone:978-766-0573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0004513225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist