Provider Demographics
NPI:1932906799
Name:MILLER, LILA R
Entity type:Individual
Prefix:
First Name:LILA
Middle Name:R
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 RABBITBRUSH DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87402-4574
Mailing Address - Country:US
Mailing Address - Phone:505-716-8075
Mailing Address - Fax:505-273-3163
Practice Address - Street 1:2705 RABBITBRUSH DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87402-4574
Practice Address - Country:US
Practice Address - Phone:505-716-8075
Practice Address - Fax:505-273-3163
Is Sole Proprietor?:No
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMOT-2024-0162224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant