Healthcare Provider Details

I. General information

NPI: 1033020888
Provider Name (Legal Business Name): CAROLYN MILES OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2026
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 BOUQUET CIR
WINDSOR CA
95492-9609
US

IV. Provider business mailing address

228 BOUQUET CIR
WINDSOR CA
95492-9609
US

V. Phone/Fax

Practice location:
  • Phone: 818-292-0951
  • Fax:
Mailing address:
  • Phone: 818-292-0951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT3015
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: