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General NPI Number Information
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NPI Number | 1093953473
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Entity Type | Individual
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Provider Name | SHA'MEL CARRISSA MILLER OTA
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Gender | Female
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Dates
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Enumeration Date | 01/23/2009
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Last Update Date | 01/23/2009
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Provider Practice Location Address
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Address Line | 1 RAPP RD
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City | ALBANY
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State | NY
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Zip | 12203-4491
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Country | US
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Telephone | 518-867-3061
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Fax | 518-867-3066
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Provider Business Mailing Address
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Address Line | 2539 6TH AVE
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City | TROY
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State | NY
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Zip | 12180-2228
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Country | US
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Telephone | 518-331-4695
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 007210-1
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License Number State | NY
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