Healthcare Provider Details

I. General information

NPI: 1750505681
Provider Name (Legal Business Name): CATHERYN LEIGH MILLER OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N 11TH ST
SAINT LOUIS MO
63101-1015
US

IV. Provider business mailing address

1720 CHOUTEAU AVE APT 402
SAINT LOUIS MO
63103-3140
US

V. Phone/Fax

Practice location:
  • Phone: 314-345-2535
  • Fax: 314-345-2653
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number1999138093
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: