MEDICARE: MS. FARRELL ANN MILLER OTR

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	225X00000X	Occupational Therapist	OT 12551	FL

General Provider Information

NPI Number	:	1952514697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. FARRELL ANN MILLER OTR

Provider Business Mailing Address
First Line	:	1689 AUSTIN LN
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32092-1050
Country	:	US
Telephone Number	:	330-256-7674
Fax Number	:

Provider Business Practice Location Address
First Line	:	1689 AUSTIN LN
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32092-1050
Country	:	US
Telephone Number	:	330-256-7674
Fax Number	:

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

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	07/08/2007

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