Provider Demographics
NPI:1184314296
Name:MILLER, HALEY NICOLE (LAT, ATC)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:NICOLE
Last Name:MILLER
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2107 W SAYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46528-5743
Mailing Address - Country:US
Mailing Address - Phone:574-349-3734
Mailing Address - Fax:
Practice Address - Street 1:JAMES A TAYLOR CAMPUS HEALTH SERVICE CB #7470
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-5743
Practice Address - Country:US
Practice Address - Phone:919-966-3655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-11
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NCLAT-60802255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program