Provider Demographics
NPI:1851125702
Name:MCMILLAN, MYKAH JAI (OTR)
Entity type:Individual
Prefix:
First Name:MYKAH
Middle Name:JAI
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2134 E BROADWAY RD UNIT 1031
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-1775
Mailing Address - Country:US
Mailing Address - Phone:509-901-5444
Mailing Address - Fax:
Practice Address - Street 1:1802 W PARKSIDE LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-1322
Practice Address - Country:US
Practice Address - Phone:602-943-5472
Practice Address - Fax:602-943-4936
Is Sole Proprietor?:No
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist