Provider Demographics
NPI:1811454390
Name:MILLER, KATIE ANNE (OTR/L)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:ANNE
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 1:2390 PORTLAND ST APT 210
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90007-1937
Mailing Address - Country:US
Mailing Address - Phone:740-336-5905
Mailing Address - Fax:
Practice Address - Street 1:9050 W CHEYENNE AVE STE 210
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-8932
Practice Address - Country:US
Practice Address - Phone:702-209-0069
Practice Address - Fax:702-750-1372
Is Sole Proprietor?:No
Enumeration Date:2019-02-21
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NV2698225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program