Provider Demographics
NPI:1316619422
Name:MILLER, ROAZENA (DR)
Entity type:Individual
Prefix:
First Name:ROAZENA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17030 130TH AVE APT 1D
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-6005
Mailing Address - Country:US
Mailing Address - Phone:971-706-7162
Mailing Address - Fax:
Practice Address - Street 1:17030 130TH AVE APT 1D
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-6005
Practice Address - Country:US
Practice Address - Phone:971-706-7162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026023225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics