Basic Information
| Provider Information | |||||||||
| NPI: | 1467100594 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | NICOLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1318 SPIKE CT | ||||||||
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| City: | NEENAH | ||||||||
| State: | WI | ||||||||
| PostalCode: | 549564355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9209153711 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1925 WOODWINDS DR | ||||||||
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| City: | WOODBURY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551254445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512320228 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2022 | ||||||||
| LastUpdateDate: | 03/17/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 106797 | MN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.