Provider Demographics
NPI:1619787280
Name:MILES, JOSALYN
Entity type:Individual
Prefix:
First Name:JOSALYN
Middle Name:
Last Name:MILES
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 1:14724 S LA GRANGE RD # 17
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-3227
Mailing Address - Country:US
Mailing Address - Phone:773-329-9237
Mailing Address - Fax:
Practice Address - Street 1:14724 S LA GRANGE RD # 17
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-3227
Practice Address - Country:US
Practice Address - Phone:773-329-9237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist