Healthcare Provider Details

I. General information

NPI: 1093154536
Provider Name (Legal Business Name): SUSAN DENISE MILLER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2013
Last Update Date: 06/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20288 HIGHWAY 15 N SUITE 100
HUTCHINSON MN
55350-5684
US

IV. Provider business mailing address

20288 HIGHWAY 15 N SUITE 100
HUTCHINSON MN
55350-5684
US

V. Phone/Fax

Practice location:
  • Phone: 320-587-2326
  • Fax: 320-234-6358
Mailing address:
  • Phone: 320-587-2326
  • Fax: 320-234-6358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License Number101451
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number101451
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: