Provider Demographics
NPI:1548712276
Name:MILLER, KENDYL JEAN
Entity type:Individual
Prefix:
First Name:KENDYL
Middle Name:JEAN
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10591 N. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:RAPID RIVER
Mailing Address - State:MI
Mailing Address - Zip Code:49878
Mailing Address - Country:US
Mailing Address - Phone:906-399-9133
Mailing Address - Fax:
Practice Address - Street 1:10591 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RAPID RIVER
Practice Address - State:MI
Practice Address - Zip Code:49878-9701
Practice Address - Country:US
Practice Address - Phone:906-399-9133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer