Provider Demographics
NPI:1932179884
Name:MILLER, AMANDA V (MOT, LOTR)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:V
Last Name:MILLER
Suffix:
Gender:F
Credentials:MOT, LOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 GAUSE BLVD E
Mailing Address - Street 2:SUITE A
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-4247
Mailing Address - Country:US
Mailing Address - Phone:985-643-4263
Mailing Address - Fax:985-643-4774
Practice Address - Street 1:2800 GAUSE BLVD E
Practice Address - Street 2:SUITE A
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-4247
Practice Address - Country:US
Practice Address - Phone:985-643-4263
Practice Address - Fax:985-643-4774
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1078487225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3A075CW49Medicare PIN