Provider Demographics
NPI:1154055911
Name:MILLER, MIA
Entity type:Individual
Prefix:MRS
First Name:MIA
Middle Name:
Last Name:MILLER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:MIA
Other - Middle Name:SHAWNTE
Other - Last Name:FELDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10404 VINEYARD BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-3739
Mailing Address - Country:US
Mailing Address - Phone:405-930-6040
Mailing Address - Fax:
Practice Address - Street 1:1717 S AIR DEPOT BLVD
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-5103
Practice Address - Country:US
Practice Address - Phone:405-384-0559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-15
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician