MEDICARE: MISS JENE' MILLER RBT

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1174076103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JENE' MILLER RBT

Provider Business Mailing Address
First Line	:	380 CLEVELAND PL STE B
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-6529
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	380 CLEVELAND PL STE B
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-6529
Country	:	US
Telephone Number	:	757-233-0003
Fax Number	:

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

Provider Enumeration Date	:	07/26/2016
Last Update Date	:	07/26/2016

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