Basic Information
| Provider Information | |||||||||
| NPI: | 1538228606 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | LORRIE | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | OTR-L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 721 RESERVOIR AVE | ||||||||
| Address2: | |||||||||
| City: | CRANSTON | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029104430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4019464250 | ||||||||
| FaxNumber: | 4012755645 | ||||||||
| Practice Location | |||||||||
| Address1: | 721 RESERVOIR AVE | ||||||||
| Address2: | |||||||||
| City: | CRANSTON | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029104430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4019464250 | ||||||||
| FaxNumber: | 4012755645 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2006 | ||||||||
| LastUpdateDate: | 04/10/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XP0200X | OT00505 | RI | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics | 225X00000X | OT00505 | RI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 409160 | 01 | RI | BLUE CHIP | OTHER | 23461-8 | 01 | RI | BLUE CROSS | OTHER |