Healthcare Provider Details

I. General information

NPI: 1881667632
Provider Name (Legal Business Name): EMILY ANN MILLER M.S., ATC, CSCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 08/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 E EMERSON ST
BLOOMINGTON IL
61701-1730
US

IV. Provider business mailing address

PO BOX 2900
BLOOMINGTON IL
61702-2900
US

V. Phone/Fax

Practice location:
  • Phone: 309-556-1289
  • Fax:
Mailing address:
  • Phone: 309-556-1289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: