Provider Demographics
NPI:1093563207
Name:MILLER, ANNA GRACE (OTD)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:GRACE
Last Name:MILLER
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7502 N HOOVER RD
Mailing Address - Street 2:
Mailing Address - City:HESSTON
Mailing Address - State:KS
Mailing Address - Zip Code:67062-9500
Mailing Address - Country:US
Mailing Address - Phone:620-869-3005
Mailing Address - Fax:
Practice Address - Street 1:218 E PACK ST
Practice Address - Street 2:
Practice Address - City:MOUNDRIDGE
Practice Address - State:KS
Practice Address - Zip Code:67107-8815
Practice Address - Country:US
Practice Address - Phone:620-345-6391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-11
Last Update Date:2024-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist