Provider Demographics
NPI:1396992483
Name:MILLER, NOEL ANN (MS OTR/L)
Entity type:Individual
Prefix:
First Name:NOEL
Middle Name:ANN
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 COBBLESTONE DR
Mailing Address - Street 2:
Mailing Address - City:RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:11961-1719
Mailing Address - Country:US
Mailing Address - Phone:631-921-8190
Mailing Address - Fax:
Practice Address - Street 1:24 COBBLESTONE DR
Practice Address - Street 2:
Practice Address - City:RIDGE
Practice Address - State:NY
Practice Address - Zip Code:11961-1719
Practice Address - Country:US
Practice Address - Phone:631-921-8190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-20
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014808172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker