Active NPI
Angelique Clark-Miller, OTR/L
- Occupational Therapist
- Louisville, KY
National Provider Identifier
1164512406
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- R2290
- Practice address
- 1227 Goss Ave
Louisville, KY 40217-1239 - Phone
- (502) 636-1200
- Fax
- (502) 636-0351
- NPI assigned
- Oct 16, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | R2290 | KY | Primary |
Addresses
Primary practice location
1227 Goss Ave
Louisville, KY 40217-1239
Mailing address
1227 Goss Ave
Louisville, KY 40217-1239
Phone (502) 636-1200
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R2290 | KY | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160956800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1164512406",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1227 GOSS AVE",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402171239",
"telephone_number": "502-636-1200",
"fax_number": "502-636-0351"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1227 GOSS AVE",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402171239",
"telephone_number": "502-636-1200",
"fax_number": "502-636-0351"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK-MILLER",
"first_name": "ANGELIQUE",
"name_prefix": "Mrs.",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "KY",
"license": "R2290",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Louisville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.