MEDICARE: KIMBERLY MILLER MA, CCC-A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231HA2400X	Assistive Technology Practitioner Audiologist	3598	NM

General Provider Information

NPI Number	:	1043213937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY MILLER MA, CCC-A

Provider Business Mailing Address
First Line	:	10200 CORRALES RD NW
Second Line	:	STE E5A
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-4532
Country	:	US
Telephone Number	:	505-890-0003
Fax Number	:

Provider Business Practice Location Address
First Line	:	10200 CORRALES RD NW
Second Line	:	STE E5A
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-4532
Country	:	US
Telephone Number	:	505-890-0003
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	04/30/2008

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