Provider Demographics
NPI:1750758454
Name:MILLER, MARYANN CRAWFORD (OTR/L)
Entity type:Individual
Prefix:
First Name:MARYANN
Middle Name:CRAWFORD
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 1:2819 CROW CANYON RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1655
Mailing Address - Country:US
Mailing Address - Phone:925-264-9810
Mailing Address - Fax:925-263-1906
Practice Address - Street 1:2819 CROW CANYON RD
Practice Address - Street 2:SUITE 205
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1655
Practice Address - Country:US
Practice Address - Phone:925-264-9810
Practice Address - Fax:925-263-1906
Is Sole Proprietor?:No
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15224225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist