Healthcare Provider Details

I. General information

NPI: 1730858580
Provider Name (Legal Business Name): MRS. CAITLIN LEIGH NIKOLE MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAITLIN KINDER

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 09/07/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 HOSPITAL DR
DOVER OH
44622-2058
US

IV. Provider business mailing address

201 HOSPITAL DR
DOVER OH
44622-2058
US

V. Phone/Fax

Practice location:
  • Phone: 330-343-6631
  • Fax: 330-343-8188
Mailing address:
  • Phone: 330-343-6631
  • Fax: 330-343-8188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.2101924-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: