Provider Demographics
NPI:1861559965
Name:MILLER, JENNIFER GRAYSON (OTR)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:GRAYSON
Last Name:MILLER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3491 HEATHERWOOD CT
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-1954
Mailing Address - Country:US
Mailing Address - Phone:404-933-1132
Mailing Address - Fax:770-947-3251
Practice Address - Street 1:3491 HEATHERWOOD COURT
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-1954
Practice Address - Country:US
Practice Address - Phone:404-933-1132
Practice Address - Fax:770-947-3251
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT003620225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist