Active NPI
Miller Killgore Dragna, OT
- Occupational Therapist
- Tyler, TX
National Provider Identifier
1760980221
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 307984
- Practice address
- 2301 S Broadway Ave Ste B10
Tyler, TX 75701-5409 - Phone
- (903) 884-7500
- NPI assigned
- Jan 30, 2018
- 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 | 307984 | LA | Primary |
Addresses
Primary practice location
2301 S Broadway Ave Ste B10
Tyler, TX 75701-5409
Mailing address
4474 Highway 534
Haynesville, LA 71038-7168
Phone (318) 245-5440
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 |
|---|---|---|---|
| 307984 | LA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1517270400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1657152000000",
"number": "1760980221",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4474 HIGHWAY 534",
"city": "HAYNESVILLE",
"state": "LA",
"postal_code": "710387168",
"telephone_number": "318-245-5440"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2301 S BROADWAY AVE STE B10",
"city": "TYLER",
"state": "TX",
"postal_code": "757015409",
"telephone_number": "903-884-7500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DRAGNA",
"first_name": "MILLER",
"middle_name": "KILLGORE",
"credential": "OT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-01-30",
"last_updated": "2022-07-07",
"certification_date": "2022-07-07",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "LA",
"license": "307984",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.