Healthcare Provider Details

I. General information

NPI: 1831757541
Provider Name (Legal Business Name): HANNAH NICOLE MILLER M.ED., ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2019
Last Update Date: 05/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E 17TH ST
BLOOMINGTON IN
47408-1590
US

IV. Provider business mailing address

4308 NORMAN AVE NW
CANTON OH
44709-1634
US

V. Phone/Fax

Practice location:
  • Phone: 330-209-9701
  • Fax:
Mailing address:
  • Phone: 330-209-9701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number36003149A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: