Healthcare Provider Details

I. General information

NPI: 1396175022
Provider Name (Legal Business Name): KELLY MILLER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2013
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 WHIPPLE AVE NW
CANTON OH
44708-1534
US

IV. Provider business mailing address

1909 BEECHWOOD AVE NE
PARIS OH
44669-9667
US

V. Phone/Fax

Practice location:
  • Phone: 330-477-5200
  • Fax:
Mailing address:
  • Phone: 330-205-4692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA.09154
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: