Individual
BRIAN A MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
316 E 14TH ST, KAUKAUNA, WI 54130-3304
(920) 766-6020
(920) 759-1937
Mailing address
316 E 14TH ST, KAUKAUNA, WI 54130-3304
(920) 766-6020
(920) 759-1937
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
4977-27
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1093786543
—
WI
Enumeration date
10/29/2013
Last updated
10/29/2013
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