Healthcare Provider Details

I. General information

NPI: 1649616897
Provider Name (Legal Business Name): HEATHER ANN MILLER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2013
Last Update Date: 05/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E ELEP AVE
COLVILLE WA
99114-5014
US

IV. Provider business mailing address

1420 MATSON RD
COLVILLE WA
99114-9578
US

V. Phone/Fax

Practice location:
  • Phone: 509-684-2573
  • Fax:
Mailing address:
  • Phone: 509-684-2731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT60369971
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: