Healthcare Provider Details

I. General information

NPI: 1144198284
Provider Name (Legal Business Name): LAURA MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2025
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 MARINE ST
SAINT AUGUSTINE FL
32084-5154
US

IV. Provider business mailing address

491 GIANNA WAY
SAINT AUGUSTINE FL
32086-3861
US

V. Phone/Fax

Practice location:
  • Phone: 904-829-3475
  • Fax:
Mailing address:
  • Phone: 229-300-9041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT12954
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: