MEDICARE: MR. HAROLD DEAN MILLER MS, ATC, LAT

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	2255A2300X	Athletic Trainer	AT4735	TX

General Provider Information

NPI Number	:	1962958884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HAROLD DEAN MILLER MS, ATC, LAT

Provider Business Mailing Address
First Line	:	PO BOX 25290
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77265
Country	:	US
Telephone Number	:	925-238-6141
Fax Number	:

Provider Business Practice Location Address
First Line	:	4218 CHILDRESS ST
Second Line	:	UNIT B
City	:	HOUSTON
State	:	TX
Zip	:	77005-1014
Country	:	US
Telephone Number	:	925-238-6141
Fax Number	:

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

Provider Enumeration Date	:	08/31/2016
Last Update Date	:	08/31/2016

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