Provider Demographics
NPI:1528284973
Name:MILLER, DAVID G (OTR, ATP)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:G
Last Name:MILLER
Suffix:
Gender:M
Credentials:OTR, ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 LOWELL DR
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-5426
Mailing Address - Country:US
Mailing Address - Phone:845-639-0719
Mailing Address - Fax:845-639-0746
Practice Address - Street 1:51-55 NORTH ROUTE 9W
Practice Address - Street 2:
Practice Address - City:WEST HAVERSTRAW
Practice Address - State:NY
Practice Address - Zip Code:10993
Practice Address - Country:US
Practice Address - Phone:845-786-4715
Practice Address - Fax:845-786-4951
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006851-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist