=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730334046
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMY MILES OT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2008
-----------------------------------------------------
Last Update Date | 12/01/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9414 NE FOURTH PLAIN RD.
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98662
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 350-892-5142
-----------------------------------------------------
Fax | 360-892-2157
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9414 NE FOURTH PLAIN RD.
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98662
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 350-892-5142
-----------------------------------------------------
Fax | 360-892-2157
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 60043271
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------