Healthcare Provider Details

I. General information

NPI: 1174292684
Provider Name (Legal Business Name): ANNA MILLER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2021
Last Update Date: 10/11/2021
Certification Date: 10/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6911 S YOSEMITE ST
CENTENNIAL CO
80112-1426
US

IV. Provider business mailing address

7585 E PEAKVIEW AVE APT 922
CENTENNIAL CO
80111-6741
US

V. Phone/Fax

Practice location:
  • Phone: 303-221-7827
  • Fax:
Mailing address:
  • Phone: 615-512-5399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT.0007090
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: