Basic Information
| Provider Information | |||||||||
| NPI: | 1619436151 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | STEPHANIE MILLER | ||||||||
| MiddleName: | N | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8100 SW 22ND ST APT A109 | ||||||||
| Address2: | |||||||||
| City: | NORTH LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330685029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 0545447822 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1750 N UNIVERSITY DR STE 105 | ||||||||
| Address2: | |||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330716075 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543562878 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2019 | ||||||||
| LastUpdateDate: | 03/14/2019 | ||||||||
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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 | OTA15346 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
ID Information
| ID | Type | State | Issuer | Description | OTA15436 | 01 | FL | BOARD OF OCCUPATIONAL THERAPY | OTHER |