Provider Demographics
NPI:1801961529
Name:MILLER, PATRICIA ANNE (MS, OTR L)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANNE
Last Name:MILLER
Suffix:
Gender:
Credentials:MS, OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4941 BENCHMARK CENTRE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-2038
Mailing Address - Country:US
Mailing Address - Phone:618-416-7227
Mailing Address - Fax:618-416-7228
Practice Address - Street 1:4941 BENCHMARK CENTRE DR STE 300
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-2038
Practice Address - Country:US
Practice Address - Phone:618-416-7227
Practice Address - Fax:618-416-7228
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056004907302F00000X
IL056.004907225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No302F00000XManaged Care OrganizationsExclusive Provider Organization