Individual
MRS. LESLIE DEAN MILLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
148 LINDEN ST, SUITE 106, WELLESLEY, MA 02482-7900
(781) 235-6440
(781) 235-3373
Mailing address
148 LINDEN ST, SUITE 106, WELLESLEY, MA 02482-7900
(781) 235-6440
(781) 235-3373
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
2577
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05-0562697
TAX IDENTIFICATION NUMBER
MA
01
—
2577
PT LISCENCE
MA
01
—
Y66819
BLUE CROSS & BLUE SHEILD
MA
01
—
Y68179
MEDICARE NUMBER
MA
Enumeration date
06/13/2006
Last updated
07/22/2008
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