Individual
MRS. CHYRL ANN MIRACLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
123 WESTERN PLAZA WAY, NEWPORT, TN 37821-2215
(423) 623-7777
(423) 623-0707
Mailing address
480 DUNCAN ST, NEWPORT, TN 37821-2016
(426) 625-9785
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT928
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3655456
—
TN
01
—
4020256
BCBS PROVIDER NUMBER
TN
Enumeration date
08/15/2005
Last updated
11/17/2014
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