Provider Demographics
NPI:1396087037
Name:MILES, ANGELA LOUISE (PTA)
Entity type:Individual
Prefix:MISS
First Name:ANGELA
Middle Name:LOUISE
Last Name:MILES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 HURSTBOURNE AVE
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-2313
Mailing Address - Country:US
Mailing Address - Phone:502-460-3590
Mailing Address - Fax:
Practice Address - Street 1:134 HURSTBOURNE AVE
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-2313
Practice Address - Country:US
Practice Address - Phone:502-460-3590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA02415252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency