Healthcare Provider Details

I. General information

NPI: 1225947419
Provider Name (Legal Business Name): SUSAN HELEN MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737 S 1300 E
SALT LAKE CITY UT
84102-3799
US

IV. Provider business mailing address

8370 W HERZOG AVE
MAGNA UT
84044-1879
US

V. Phone/Fax

Practice location:
  • Phone: 801-582-5104
  • Fax:
Mailing address:
  • Phone: 732-470-6333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number14306192-4003
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: