Healthcare Provider Details

I. General information

NPI: 1801961529
Provider Name (Legal Business Name): PATRICIA ANNE MILLER MS, OTR L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4941 BENCHMARK CENTRE DR STE 300
SWANSEA IL
62226-2038
US

IV. Provider business mailing address

4941 BENCHMARK CENTRE DR STE 300
SWANSEA IL
62226-2038
US

V. Phone/Fax

Practice location:
  • Phone: 618-416-7227
  • Fax: 618-416-7228
Mailing address:
  • Phone: 618-416-7227
  • Fax: 618-416-7228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number056004907
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number056.004907
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: