MEDICARE: MR. ROBERT SCOTT MILLER MSW

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	1041C0700X	Clinical Social Worker	LW00005444	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LW00005444	OTHER	WA	SOCIAL WORK LICENSE

General Provider Information

NPI Number	:	1477557338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT SCOTT MILLER MSW

Provider Business Mailing Address
First Line	:	275 SE CABOT DR
Second Line	:	STE B206
City	:	OAK HARBOR
State	:	WA
Zip	:	98277-3755
Country	:	US
Telephone Number	:	360-240-8090
Fax Number	:	360-279-2440

Provider Business Practice Location Address
First Line	:	275 SE CABOT DR
Second Line	:	STE B206
City	:	OAK HARBOR
State	:	WA
Zip	:	98277-3755
Country	:	US
Telephone Number	:	360-240-8090
Fax Number	:	360-279-2440

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	07/08/2007

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