Provider Demographics
NPI:1104198761
Name:MILLER, JENNA MEADS (COTA/L, CLT, PCC)
Entity type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:MEADS
Last Name:MILLER
Suffix:
Gender:F
Credentials:COTA/L, CLT, PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 CENTER CROSS DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-5176
Mailing Address - Country:US
Mailing Address - Phone:252-340-4774
Mailing Address - Fax:
Practice Address - Street 1:208 HASTINGS LN
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-3324
Practice Address - Country:US
Practice Address - Phone:252-338-4066
Practice Address - Fax:252-338-4069
Is Sole Proprietor?:No
Enumeration Date:2012-01-29
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8165224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant