MEDICARE: MR. MICHAEL A MINER OTR L

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	225X00000X	Occupational Therapist	0693	NV

General Provider Information

NPI Number	:	1609838879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL A MINER OTR L

Provider Business Mailing Address
First Line	:	978 MOUNTAIN CITY HWY
Second Line	:
City	:	ELKO
State	:	NV
Zip	:	89801-2881
Country	:	US
Telephone Number	:	775-738-4666
Fax Number	:	775-738-4776

Provider Business Practice Location Address
First Line	:	978 MOUNTAIN CITY HWY
Second Line	:
City	:	ELKO
State	:	NV
Zip	:	89801-2881
Country	:	US
Telephone Number	:	775-738-4666
Fax Number	:	775-738-4776

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

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	05/23/2015

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