Healthcare Provider Details

I. General information

NPI: 1578442331
Provider Name (Legal Business Name): TERESA BREWER MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 STEEL ST
HAZARD KY
41701-5434
US

IV. Provider business mailing address

133 STEEL ST
HAZARD KY
41701-5434
US

V. Phone/Fax

Practice location:
  • Phone: 606-438-9761
  • Fax:
Mailing address:
  • Phone: 606-438-9761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number252Y00000X
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: