Basic Information
| Provider Information | |||||||||
| NPI: | 1063915130 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MIELKE | ||||||||
| FirstName: | ARIANNA | ||||||||
| MiddleName: | LAUREN | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 435 4TH ST | ||||||||
| Address2: | |||||||||
| City: | TROY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 121805324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5182716777 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2902 RIVERVIEW ROAD | ||||||||
| Address2: | |||||||||
| City: | GREEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12183 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5184662752 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2018 | ||||||||
| LastUpdateDate: | 03/14/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 022304 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.