MEDICARE: MS. ASHLEY H MILLER

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	225XP0200X	Pediatric Occupational Therapist	OTR1865	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639280217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ASHLEY H MILLER

Provider Business Mailing Address
First Line	:	3747 W MAHOGANY DR
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72704-7079
Country	:	US
Telephone Number	:	501-412-6384
Fax Number	:

Provider Business Practice Location Address
First Line	:	3747 W MAHOGANY DR
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72704-7079
Country	:	US
Telephone Number	:	501-412-6384
Fax Number	:

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	05/22/2012

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