Healthcare Provider Details

I. General information

NPI: 1063137453
Provider Name (Legal Business Name): SIERRA LYNN MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2022
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6635 W HAPPY VALLEY RD STE A104-218
GLENDALE AZ
85310-2609
US

IV. Provider business mailing address

3559 E ELEANA LN
GILBERT AZ
85298-4240
US

V. Phone/Fax

Practice location:
  • Phone: 623-224-1214
  • Fax:
Mailing address:
  • Phone: 480-710-1899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: