Healthcare Provider Details

I. General information

NPI: 1265693865
Provider Name (Legal Business Name): MRS. SONIA MILLS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SONIA MILLS OTR/L

II. Dates (important events)

Enumeration Date: 06/17/2008
Last Update Date: 06/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2698 SE CARTHAGE RD
PORT ST LUCIE FL
34952-5201
US

IV. Provider business mailing address

2698 SE CARTHAGE RD
PORT ST LUCIE FL
34952-5201
US

V. Phone/Fax

Practice location:
  • Phone: 772-240-1812
  • Fax: 772-398-8680
Mailing address:
  • Phone: 772-240-1812
  • Fax: 772-398-8680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2224
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: