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NPI Code Detail

MEDICARE: ANGELIA RENEE MILNER

MEDICARE: ANGELIA RENEE MILNER
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
1224Z00000XOccupational Therapy Assistant057.004098IL

General Provider Information

NPI Number : 1588249031
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELIA RENEE MILNER
Provider Business Mailing Address
First Line : 3454 SELMAVILLE RD
Second Line :
City : SALEM
State : IL
Zip : 62881-5800
Country : US
Telephone Number : 618-367-6512
Fax Number :
Provider Business Practice Location Address
First Line : 1910 E MCCORD ST
Second Line :
City : CENTRALIA
State : IL
Zip : 62801-6586
Country : US
Telephone Number : 618-533-1200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2021
Last Update Date : 03/16/2021

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Directions to “ ANGELIA RENEE MILNER ” Practice Location

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