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NPI Code Detail

MEDICARE: MRS. KIMBERLY SHAE MILLER COTA/L

MEDICARE: MRS. KIMBERLY SHAE MILLER COTA/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
1224Z00000XOccupational Therapy Assistant1258NV

General Provider Information

NPI Number : 1710271309
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KIMBERLY SHAE MILLER COTA/L
Provider Business Mailing Address
First Line : 2933 BRANCH CREEK CT
Second Line :
City : LAS VEGAS
State : NV
Zip : 89135-2094
Country : US
Telephone Number : 702-305-5015
Fax Number :
Provider Business Practice Location Address
First Line : 5110 W SAHARA AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89146-3406
Country : US
Telephone Number : 702-352-9260
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2011
Last Update Date : 06/01/2011

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