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General NPI Number Information
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NPI Number | 1548479942
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Entity Type | Individual
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Provider Name | JENNIFER MILLER ATC, LAT, OTC, NREMT
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Gender | Female
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 209 S 36TH ST
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City | MUSKOGEE
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State | OK
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Zip | 74401-5043
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Country | US
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Telephone | 918-682-7717
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Fax |
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Provider Business Mailing Address
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Address Line | 8105 E 93RD ST #809
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City | TULSA
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State | OK
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Zip | 74133-5507
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Country | US
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Telephone |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 347
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License Number State | OK
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