Provider Demographics
NPI:1043331770
Name:MILLER, JENNIFER GAYLE (MA, ATC, LAT)
Entity type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:GAYLE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MA, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2113 CASEMENT RD
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-4720
Mailing Address - Country:US
Mailing Address - Phone:785-532-1156
Mailing Address - Fax:
Practice Address - Street 1:2201 KIMBALL AVE
Practice Address - Street 2:KANSAS STATE UNIVERSITY - SPORTS MEDICINE
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-3314
Practice Address - Country:US
Practice Address - Phone:785-410-7192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT-2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer