1154505634 NPI number — THOMAS T MILLER LIFE COACH CONSULTANT LLC

Table of content: (NPI 1154505634)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154505634 NPI number — THOMAS T MILLER LIFE COACH CONSULTANT LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMAS T MILLER LIFE COACH CONSULTANT LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1154505634
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/20/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4745 ESTERO BLVD
Provider Second Line Business Mailing Address:
UNIT 305
Provider Business Mailing Address City Name:
FORT MYERS BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33931-3981
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-765-6906
Provider Business Mailing Address Fax Number:
239-765-6906

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10085 UPP RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VAN WERT
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45891-8406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-238-6646
Provider Business Practice Location Address Fax Number:
419-238-6646
Provider Enumeration Date:
12/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
T
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
419-238-6646

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  1381 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0257529 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 34131107400 . This is a "OH WORKERS COMP" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com