Basic Information
| Provider Information | |||||||||
| NPI: | 1306406095 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MILO | ||||||||
| FirstName: | DENISE | ||||||||
| MiddleName: | LYNETTE | ||||||||
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| Credential: | COTA/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4201 MATT CT | ||||||||
| Address2: | |||||||||
| City: | KILLEEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 765494778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5755452222 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2125 S 61ST ST | ||||||||
| Address2: | |||||||||
| City: | TEMPLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 765046823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2547749991 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2019 | ||||||||
| LastUpdateDate: | 06/16/2019 | ||||||||
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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 | 224Z00000X | 215647 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.