Provider Demographics
NPI:1497200232
Name:MILLER, TRISHA LYNN (ATC)
Entity type:Individual
Prefix:MS
First Name:TRISHA
Middle Name:LYNN
Last Name:MILLER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5638 OLD ROUTE 70
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45502-9312
Mailing Address - Country:US
Mailing Address - Phone:937-360-8555
Mailing Address - Fax:
Practice Address - Street 1:5638 OLD ROUTE 70
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45502-9312
Practice Address - Country:US
Practice Address - Phone:937-360-8555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0042512255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer