Healthcare Provider Details

I. General information

NPI: 1427480037
Provider Name (Legal Business Name): TRICIA ANNE MILLER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2013
Last Update Date: 08/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3908 PINE LN
SAINT BONIFACIUS MN
55375-1223
US

IV. Provider business mailing address

3908 PINE LN
SAINT BONIFACIUS MN
55375-1223
US

V. Phone/Fax

Practice location:
  • Phone: 952-446-9426
  • Fax:
Mailing address:
  • Phone: 952-446-9426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number102849
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: