Healthcare Provider Details

I. General information

NPI: 1477466928
Provider Name (Legal Business Name): EVAN MILLER OT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 WATERFORD ST
EDINBORO PA
16412-5517
US

IV. Provider business mailing address

8477 S SUNCOAST BLVD
HOMOSASSA FL
34446-5028
US

V. Phone/Fax

Practice location:
  • Phone: 814-734-5021
  • Fax:
Mailing address:
  • Phone: 800-381-0822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC020636
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: