1457532335 NPI number — MRS. ROBIN ELAINE KENNEL MILLER MS, LAT, ATC, CSCS

Table of content: MRS. ROBIN ELAINE KENNEL MILLER MS, LAT, ATC, CSCS (NPI 1457532335)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457532335 NPI number — MRS. ROBIN ELAINE KENNEL MILLER MS, LAT, ATC, CSCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
ROBIN
Provider Middle Name:
ELAINE KENNEL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, LAT, ATC, CSCS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KENNEL
Provider Other First Name:
ROBIN
Provider Other Middle Name:
ELAINE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, LAT, ATC, CSCS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1457532335
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/19/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 458
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLLY SPRINGS
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27540-0458
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-216-4846
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4844 SUNSET FOREST CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOLLY SPRINGS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27540-7831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-216-4846
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/19/2007

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: 2255A2300X , with the licence number:  0789 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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