Provider Demographics
NPI:1881739795
Name:MILLER, CURTIS COURTLAND II (MIA CCCA FAAA)
Entity type:Individual
Prefix:
First Name:CURTIS
Middle Name:COURTLAND
Last Name:MILLER
Suffix:II
Gender:M
Credentials:MIA CCCA FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 NORTH 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-3079
Mailing Address - Country:US
Mailing Address - Phone:360-681-7500
Mailing Address - Fax:360-681-7717
Practice Address - Street 1:538 NORTH 5TH AVE
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3079
Practice Address - Country:US
Practice Address - Phone:360-681-7500
Practice Address - Fax:360-681-7717
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD00003735231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7138985Medicaid
8867879Medicare PIN