Healthcare Provider Details

I. General information

NPI: 1639089337
Provider Name (Legal Business Name): IAN J MILLER OTR, OTL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MILK ST
METHUEN MA
01844-4662
US

IV. Provider business mailing address

920 BROADWAY
HAVERHILL MA
01832-1158
US

V. Phone/Fax

Practice location:
  • Phone: 978-685-0659
  • Fax:
Mailing address:
  • Phone: 978-476-3531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTL36724
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: