Provider Demographics
NPI:1063697910
Name:MILLER, BOBBETTE JEAN (DPT)
Entity type:Individual
Prefix:
First Name:BOBBETTE
Middle Name:JEAN
Last Name:MILLER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:BOBBETTE
Other - Middle Name:JEAN
Other - Last Name:HICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:820 NE 15TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-4602
Mailing Address - Country:US
Mailing Address - Phone:405-271-6242
Mailing Address - Fax:405-271-2887
Practice Address - Street 1:820 NE 15TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-4602
Practice Address - Country:US
Practice Address - Phone:405-271-6242
Practice Address - Fax:405-271-2887
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0011631225100000X
OK55602251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist