Provider Demographics
NPI:1912139395
Name:MILLER, KRISTEN WILSON (OT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:WILSON
Last Name:MILLER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MISS
Other - First Name:KRISTEN
Other - Middle Name:MICHELE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:PO BOX 601791
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1791
Mailing Address - Country:US
Mailing Address - Phone:704-384-7834
Mailing Address - Fax:
Practice Address - Street 1:1035 LINCOLNTON RD
Practice Address - Street 2:SUITE A
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-6277
Practice Address - Country:US
Practice Address - Phone:704-603-1352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-18
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2463225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist