Provider Demographics
NPI:1588084727
Name:MILLER, LEOTA
Entity type:Individual
Prefix:
First Name:LEOTA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 W DOWNING ST
Mailing Address - Street 2:APT C
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-2701
Mailing Address - Country:US
Mailing Address - Phone:918-718-9422
Mailing Address - Fax:918-456-1407
Practice Address - Street 1:218 W DOWNING ST
Practice Address - Street 2:APT C
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-2701
Practice Address - Country:US
Practice Address - Phone:918-718-9422
Practice Address - Fax:918-456-1407
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-25
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker