Healthcare Provider Details

I. General information

NPI: 1932936325
Provider Name (Legal Business Name): KAITLIN MILLER HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2024
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 PLANTATION PARK DR STE 108
BLUFFTON SC
29910-6033
US

IV. Provider business mailing address

10 PLANTATION PARK DR STE 108
BLUFFTON SC
29910-6033
US

V. Phone/Fax

Practice location:
  • Phone: 843-474-0588
  • Fax: 888-965-6992
Mailing address:
  • Phone: 843-474-0588
  • Fax: 888-965-6992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHAS-0760
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: