Provider Demographics
NPI:1639459886
Name:MILLER, LEIGH ANN (OTR)
Entity type:Individual
Prefix:MRS
First Name:LEIGH ANN
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:LEIGH ANN
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 52ND ST
Mailing Address - Street 2:STE 240
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53140-3423
Mailing Address - Country:US
Mailing Address - Phone:262-925-5000
Mailing Address - Fax:262-925-5001
Practice Address - Street 1:7137 236TH AVE
Practice Address - Street 2:STE 101
Practice Address - City:SALEM
Practice Address - State:WI
Practice Address - Zip Code:53168-8975
Practice Address - Country:US
Practice Address - Phone:262-925-5060
Practice Address - Fax:262-925-5061
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5050-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI391730425OtherOUT PATIENT PHYSICAL AND OCCUPATIONAL THERAPY CLINIC