MEDICARE: MRS. MARLENE MILLS

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	224Z00000X	Occupational Therapy Assistant	0000638	CO

General Provider Information

NPI Number	:	1598141533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARLENE MILLS

Provider Business Mailing Address
First Line	:	4210 ROSALIE ST UNIT 102
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-4916
Country	:	US
Telephone Number	:	719-290-8717
Fax Number	:

Provider Business Practice Location Address
First Line	:	4210 ROSALIE ST UNIT 102
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-4916
Country	:	US
Telephone Number	:	719-290-8717
Fax Number	:

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

Provider Enumeration Date	:	07/31/2015
Last Update Date	:	07/31/2015

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