Provider Demographics
NPI:1528797040
Name:MILLER, KENZIE RENEE (OT)
Entity type:Individual
Prefix:
First Name:KENZIE
Middle Name:RENEE
Last Name:MILLER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:KENZIE
Other - Middle Name:
Other - Last Name:SALZBRENNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4251 LAHMEYER RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-5676
Mailing Address - Country:US
Mailing Address - Phone:260-432-4700
Mailing Address - Fax:
Practice Address - Street 1:1031 S 13TH ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IN
Practice Address - Zip Code:46733-1807
Practice Address - Country:US
Practice Address - Phone:260-702-0410
Practice Address - Fax:260-724-7778
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31007726A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist