Provider Demographics
NPI:1487969135
Name:MILLER, ALICIA (OT)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25554 JOMEAN DR
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24211-4295
Mailing Address - Country:US
Mailing Address - Phone:276-619-1350
Mailing Address - Fax:276-739-0026
Practice Address - Street 1:610 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-2589
Practice Address - Country:US
Practice Address - Phone:276-525-1587
Practice Address - Fax:276-525-1609
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-18
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119003782225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist