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General NPI Number Information
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NPI Number | 1881338440
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Entity Type | Individual
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Provider Name | JESSICA MARIE MILLER OTR
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Gender | Female
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Dates
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Enumeration Date | 04/20/2022
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Last Update Date | 04/20/2022
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Provider Practice Location Address
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Address Line | 6246 RIVINGTON DR
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City | INDIANAPOLIS
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State | IN
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Zip | 46236-8285
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Country | US
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Telephone | 317-296-4830
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Fax |
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Provider Business Mailing Address
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Address Line | 12125 E 65TH ST UNIT 36313
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City | INDIANAPOLIS
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State | IN
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Zip | 46236-4613
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Country | US
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Telephone | 317-654-7702
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 31004220A
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License Number State | IN
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