MEDICARE: LISA M MILLAN

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	224Z00000X	Occupational Therapy Assistant	OTA13252	FL

General Provider Information

NPI Number	:	1396672440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA M MILLAN

Provider Business Mailing Address
First Line	:	9756 NW 15TH ST
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33024-4368
Country	:	US
Telephone Number	:	954-557-5428
Fax Number	:

Provider Business Practice Location Address
First Line	:	9756 NW 15TH ST
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33024-4368
Country	:	US
Telephone Number	:	954-557-5428
Fax Number	:

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

Provider Enumeration Date	:	05/05/2026
Last Update Date	:	05/05/2026

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Directions to “ LISA M MILLAN ” Practice Location

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