Healthcare Provider Details

I. General information

NPI: 1346372299
Provider Name (Legal Business Name): CAROL L MILLER M.A., ATR-BC, LCAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 OLDE TOWNE RD
ITHACA NY
14850-9472
US

IV. Provider business mailing address

106 OLDE TOWNE RD
ITHACA NY
14850-9472
US

V. Phone/Fax

Practice location:
  • Phone: 607-256-9693
  • Fax:
Mailing address:
  • Phone: 607-256-9693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number000590-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: