Basic Information
| Provider Information | |||||||||
| NPI: | 1710472188 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | BRANDI | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Credential: | MOT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6000 HAMPTON CTR STE B | ||||||||
| Address2: | |||||||||
| City: | MORGANTOWN | ||||||||
| State: | WV | ||||||||
| PostalCode: | 265051748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045991500 | ||||||||
| FaxNumber: | 3045997800 | ||||||||
| Practice Location | |||||||||
| Address1: | 150 JOHN ST STE C | ||||||||
| Address2: | |||||||||
| City: | WESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 26452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045171560 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2018 | ||||||||
| LastUpdateDate: | 04/10/2019 | ||||||||
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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 | 225X00000X | OT.0005920 | CO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.