Provider Demographics
NPI:1902056377
Name:MILLARD, DARLENE MARGARET (COTA)
Entity Type:Individual
Prefix:MS
First Name:DARLENE
Middle Name:MARGARET
Last Name:MILLARD
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7540 N 19TH AVE
Mailing Address - Street 2:#200
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-7967
Mailing Address - Country:US
Mailing Address - Phone:888-873-4221
Mailing Address - Fax:888-543-2289
Practice Address - Street 1:305 TAYLOR BTLR
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:KY
Practice Address - Zip Code:41006
Practice Address - Country:US
Practice Address - Phone:859-472-2217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-AO534224Z00000X
OHOTA 00832224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant