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General NPI Number Information
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NPI Number | 1104101815
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Entity Type | Individual
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Provider Name | LISA ANNE MILLER OTR/L
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Gender | Female
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Dates
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Enumeration Date | 10/13/2011
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Last Update Date | 10/13/2011
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Provider Practice Location Address
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Address Line | 5944 WOODED ESTATES LN
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City | EDWARDSVILLE
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State | IL
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Zip | 62025-5811
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Country | US
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Telephone | 618-409-8073
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Fax | 618-692-0942
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Provider Business Mailing Address
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Address Line | 5944 WOODED ESTATES LN
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City | EDWARDSVILLE
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State | IL
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Zip | 62025-5811
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Country | US
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Telephone | 618-409-8073
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Fax | 618-692-0942
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 056009534
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License Number State | IL
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