Healthcare Provider Details

I. General information

NPI: 1447722293
Provider Name (Legal Business Name): VANESSA RANEE MEJIA-MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VANESSA RANEE HOLTON OTRL

II. Dates (important events)

Enumeration Date: 12/18/2018
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date: 09/10/2026
Reactivation Date: 09/23/2026

III. Provider practice location address

3071 E RAY RD
GILBERT AZ
85296-1696
US

IV. Provider business mailing address

3071 E RAY RD
GILBERT AZ
85296-1696
US

V. Phone/Fax

Practice location:
  • Phone: 517-706-7505
  • Fax:
Mailing address:
  • Phone: 517-706-7505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTH-009385
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: