Individual
KELSEY MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
405 W JACKSON ST, CARBONDALE, IL 62901-1462
(618) 549-0721
Mailing address
405 W JACKSON ST, PO BOX 10000, CARBONDALE, IL 62901-1462
(618) 549-0721
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056009319
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
370618939001
—
IL
05
—
370618939402
—
IL
Enumeration date
09/11/2012
Last updated
09/11/2012
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