MEDICARE: MS. TASSY MILLER M.S.

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	103K00000X	Behavior Analyst	1-13-14313	FL

General Provider Information

NPI Number	:	1902202849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TASSY MILLER M.S.

Provider Business Mailing Address
First Line	:	905 ROBERTS CUT OFF RD
Second Line	:
City	:	RIVER OAKS
State	:	TX
Zip	:	76114-2825
Country	:	US
Telephone Number	:	817-731-2293
Fax Number	:	817-886-0841

Provider Business Practice Location Address
First Line	:	905 ROBERTS CUT OFF RD # RC
Second Line	:
City	:	RIVER OAKS
State	:	TX
Zip	:	76114-2825
Country	:	US
Telephone Number	:	817-731-2293
Fax Number	:	817-886-0841

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

Provider Enumeration Date	:	11/04/2014
Last Update Date	:	03/13/2023

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