Provider Demographics
NPI:1154888444
Name:MILLER, EMILY (ATS, LMT)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:ATS, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 TEXAS AVE APT 209
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-4267
Mailing Address - Country:US
Mailing Address - Phone:920-723-4644
Mailing Address - Fax:
Practice Address - Street 1:2050 4TH AVE
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-1910
Practice Address - Country:US
Practice Address - Phone:920-723-4644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-22
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13906-146225700000X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist