Healthcare Provider Details

I. General information

NPI: 1679500235
Provider Name (Legal Business Name): MARILYN KAY MILLER PHD, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E 2ND ST DEPT. OF EXERCISE SCIENCE
BLOOMSBURG PA
17815-1301
US

IV. Provider business mailing address

2 DELWOOD DR
DANVILLE PA
17821-8528
US

V. Phone/Fax

Practice location:
  • Phone: 570-389-4356
  • Fax:
Mailing address:
  • Phone: 570-271-2914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: