Provider Demographics
NPI:1972573517
Name:MILLER, ROBIN ELLEN (OTRL CHT)
Entity type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:ELLEN
Last Name:MILLER
Suffix:
Gender:F
Credentials:OTRL CHT
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:MILLER
Other - Last Name:WAGMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL CHT
Mailing Address - Street 1:2000 W COMMERCIAL BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3060
Mailing Address - Country:US
Mailing Address - Phone:954-351-0511
Mailing Address - Fax:954-351-0411
Practice Address - Street 1:2000 W COMMERCIAL BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-3060
Practice Address - Country:US
Practice Address - Phone:954-351-0511
Practice Address - Fax:954-351-0411
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 0000194225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0442920001OtherMEDICARE DME
FL880569500Medicaid
FLZ0854ZOtherMEDICARE ID-TYPE UNSPECIFIED
FLAG243OtherMEDICARE PTAN GROUP