Healthcare Provider Details

I. General information

NPI: 1376221952
Provider Name (Legal Business Name): KATERINA B MILLER ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2023
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20920 W 151ST ST
OLATHE KS
66061-7247
US

IV. Provider business mailing address

4729 MELROSE LN
SHAWNEE KS
66203-1162
US

V. Phone/Fax

Practice location:
  • Phone: 913-782-1148
  • Fax:
Mailing address:
  • Phone: 913-953-1438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: