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NPI Code Detail

MEDICARE: MACI MILLER LCOTA

MEDICARE: MACI MILLER LCOTA
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
1225X00000XOccupational TherapistOTA.200361LA

General Provider Information

NPI Number : 1073918942
Entity Type Code : Individual
Provider Name (Legal Business Name) : MACI MILLER LCOTA
Provider Business Mailing Address
First Line : 1804 AUDUBON TRCE
Second Line :
City : JEFFERSON
State : LA
Zip : 70121-1579
Country : US
Telephone Number : 504-495-7571
Fax Number :
Provider Business Practice Location Address
First Line : 4899 WESTBANK EXPY STE D
Second Line :
City : MARRERO
State : LA
Zip : 70072-3037
Country : US
Telephone Number : 504-341-7300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/04/2014
Last Update Date : 11/04/2014

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Directions to “ MACI MILLER LCOTA” Practice Location

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