1083645295 NPI number — CHERIE B. MILLER-GRAY OTR/L, CHT

Table of content: CHERIE B. MILLER-GRAY OTR/L, CHT (NPI 1083645295)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083645295 NPI number — CHERIE B. MILLER-GRAY OTR/L, CHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER-GRAY
Provider First Name:
CHERIE
Provider Middle Name:
B.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTR/L, CHT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083645295
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
55 E NARANJA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORO VALLEY
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85737-8605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-400-8053
Provider Business Mailing Address Fax Number:
520-901-3985

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1551 EAST TANGERINE ROAD
Provider Second Line Business Practice Location Address:
OUTPATIENT THERAPY - HAND THERAPIST
Provider Business Practice Location Address City Name:
ORO VALLEY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85755-6683
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-901-3580
Provider Business Practice Location Address Fax Number:
520-901-3985
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  0342 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 770645 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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