Healthcare Provider Details

I. General information

NPI: 1578992764
Provider Name (Legal Business Name): KIM L. MILLER MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2013
Last Update Date: 11/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 MADISON AVE KCC 2
NEW YORK NY
10029-6508
US

IV. Provider business mailing address

101 W 90TH ST APT. 10 J
NEW YORK NY
10024-1200
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-1912
  • Fax:
Mailing address:
  • Phone: 949-533-9221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number016982
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: