MEDICARE: MONTIA SHANAY 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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1932763422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONTIA SHANAY MILLER

Provider Business Mailing Address
First Line	:	5900 HAMPTON CV
Second Line	:
City	:	WESTERVILLE
State	:	OH
Zip	:	43081-8875
Country	:	US
Telephone Number	:	614-353-2836
Fax Number	:

Provider Business Practice Location Address
First Line	:	5900 SHARON WOODS BLVD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-2600
Country	:	US
Telephone Number	:	614-895-6818
Fax Number	:

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

Provider Enumeration Date	:	04/30/2019
Last Update Date	:	04/30/2019

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