Individual
TIMOTHY E MILLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CPO
Contact information
Practice address
4505 UTICA RIDGE RD, BETTENDORF, IA 52722-1641
(563) 344-4206
(563) 344-4209
Mailing address
1764 YANKEE AVE, NEW LIBERTY, IA 52765-9303
(563) 785-6145
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
—
—
224P00000X
Prosthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0118281
—
IA
05
—
421429042001
—
IL
Enumeration date
06/30/2005
Last updated
03/27/2017
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