Provider Demographics
NPI:1285267112
Name:MILLER, CARRIE B (PTA)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:B
Last Name:MILLER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:B
Other - Last Name:TUTTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:PO BOX 468
Mailing Address - Street 2:
Mailing Address - City:SKOWHEGAN
Mailing Address - State:ME
Mailing Address - Zip Code:04976-0468
Mailing Address - Country:US
Mailing Address - Phone:207-858-8367
Mailing Address - Fax:
Practice Address - Street 1:57 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:SKOWHEGAN
Practice Address - State:ME
Practice Address - Zip Code:04976-1414
Practice Address - Country:US
Practice Address - Phone:207-474-7000
Practice Address - Fax:207-858-4772
Is Sole Proprietor?:No
Enumeration Date:2020-02-19
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA2810225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant