Healthcare Provider Details

I. General information

NPI: 1619787280
Provider Name (Legal Business Name): JOSALYN MILES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2025
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14724 S LA GRANGE RD # 17
ORLAND PARK IL
60462-3227
US

IV. Provider business mailing address

14724 S LA GRANGE RD # 17
ORLAND PARK IL
60462-3227
US

V. Phone/Fax

Practice location:
  • Phone: 773-329-9237
  • Fax:
Mailing address:
  • Phone: 773-329-9237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: