| NPI | 1598165797 |
|---|---|
| Former Name | JODY DIANE MILLER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: WV AT001362) |
| Enumeration Date | 2014-08-26 |
| Last Update Date | 2014-08-26 |