Individual
NICOLE MILLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.T.
Contact information
Practice address
4750 THATCHWOOD DR, MANLIUS, NY 13104-1544
(315) 420-1720
Mailing address
4750 THATCHWOOD DR, MANLIUS, NY 13104-1544
(315) 420-1720
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
017320
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
017320
NYS LICENSE
NY
Enumeration date
03/13/2019
Last updated
01/19/2023
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