Active NPI
Shontae Latrice Miller
- Recreation Therapist
- Detroit, MI
National Provider Identifier
1235792490
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Recreation Therapist
- License
- 80381
- Practice address
- 19733 Annchester Rd
Detroit, MI 48219-2191 - Phone
- (248) 238-0426
- NPI assigned
- Apr 15, 2019
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Recreation Therapist | 225800000X | 80381 | Primary |
Addresses
Primary practice location
19733 Annchester Rd
Detroit, MI 48219-2191
Mailing address
19733 Annchester Rd
Detroit, MI 48219-2191
Phone (248) 238-0426
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)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1555286400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1555286400000",
"number": "1235792490",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19733 ANNCHESTER RD",
"city": "DETROIT",
"state": "MI",
"postal_code": "482192191",
"telephone_number": "248-238-0426"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19733 ANNCHESTER RD",
"city": "DETROIT",
"state": "MI",
"postal_code": "482192191",
"telephone_number": "248-238-0426"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLER",
"first_name": "SHONTAE",
"middle_name": "LATRICE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-04-15",
"last_updated": "2019-04-15",
"status": "A"
},
"taxonomies": [
{
"code": "225800000X",
"taxonomy_group": "",
"desc": "Recreation Therapist",
"state": null,
"license": "80381",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.