MEDICARE: JENNA RAE MILLER OT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	5201009155	MI
2	225X00000X	Occupational Therapist	OT.008941	OH

General Provider Information

NPI Number	:	1275909293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA RAE MILLER OT

Provider Business Mailing Address
First Line	:	1525 W MAUMEE ST # 3
Second Line	:
City	:	ADRIAN
State	:	MI
Zip	:	49221-1899
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1525 W MAUMEE ST # 3
Second Line	:
City	:	ADRIAN
State	:	MI
Zip	:	49221-1899
Country	:	US
Telephone Number	:	517-265-6007
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2015
Last Update Date	:	08/13/2015

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