MEDICARE: SARA MILLER MS, LAT, ATC

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	2255A2300X	Athletic Trainer	24-01422	KS

General Provider Information

NPI Number	:	1326662164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA MILLER MS, LAT, ATC

Provider Business Mailing Address
First Line	:	1330 S CITY VIEW CIR
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67235-3447
Country	:	US
Telephone Number	:	316-293-6250
Fax Number	:

Provider Business Practice Location Address
First Line	:	1824 E JAMES ST
Second Line	:
City	:	DERBY
State	:	KS
Zip	:	67037-8634
Country	:	US
Telephone Number	:	316-293-6250
Fax Number	:

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

Provider Enumeration Date	:	06/07/2020
Last Update Date	:	06/07/2020

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