MEDICARE: KAYSHE MILES OTD, OTR/L

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	225XP0019X	Physical Rehabilitation Occupational Therapist	0007614	CO

General Provider Information

NPI Number	:	1639895675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYSHE MILES OTD, OTR/L

Provider Business Mailing Address
First Line	:	590 S ROCKY HILL RD
Second Line	:
City	:	GALENA
State	:	IL
Zip	:	61036-9117
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3470 S SHERMAN ST
Second Line	:
City	:	ENGLEWOOD
State	:	CO
Zip	:	80113-2680
Country	:	US
Telephone Number	:	563-581-4868
Fax Number	:

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

Provider Enumeration Date	:	10/12/2022
Last Update Date	:	12/11/2025

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