Basic Information
| Provider Information | |||||||||
| NPI: | 1992292700 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | KIRSTIE | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | RBT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12650 HAMILTON CROSSING BLVD | ||||||||
| Address2: | |||||||||
| City: | CARMEL | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460325400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3172492242 | ||||||||
| FaxNumber: | 3176631175 | ||||||||
| Practice Location | |||||||||
| Address1: | 3595 SAGAMORE PKWY N # 5 | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 479041095 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7652697756 | ||||||||
| FaxNumber: | 3176631175 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2018 | ||||||||
| LastUpdateDate: | 04/17/2018 | ||||||||
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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 | 106S00000X | Y |
No ID Information.