Healthcare Provider Details

I. General information

NPI: 1588084727
Provider Name (Legal Business Name): LEOTA MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2014
Last Update Date: 01/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 W DOWNING ST APT C
TAHLEQUAH OK
74464-2701
US

IV. Provider business mailing address

218 W DOWNING ST APT C
TAHLEQUAH OK
74464-2701
US

V. Phone/Fax

Practice location:
  • Phone: 918-718-9422
  • Fax: 918-456-1407
Mailing address:
  • Phone: 918-718-9422
  • Fax: 918-456-1407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: