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General NPI Number Information
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NPI Number | 1083388102
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Entity Type | Individual
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Provider Name | CAITLYN MARIE MILLER PTA
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Gender | Female
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Dates
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Enumeration Date | 08/03/2021
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Last Update Date | 08/03/2021
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Provider Practice Location Address
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Address Line | 3 POST OFFICE RD STE 105
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City | WALDORF
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State | MD
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Zip | 20602-2756
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Country | US
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Telephone | 301-893-2345
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Fax |
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Provider Business Mailing Address
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Address Line | 2510 SMITH POINT RD
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City | NANJEMOY
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State | MD
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Zip | 20662-3513
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Country | US
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Telephone | 240-585-2976
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | A5523
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License Number State | MD
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