Healthcare Provider Details

I. General information

NPI: 1225428519
Provider Name (Legal Business Name): MELISSA JOY MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2015
Last Update Date: 01/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4825 E MICHIGAN AVE
AU GRES MI
48703-9468
US

IV. Provider business mailing address

4825 E MICHIGAN AVE
AU GRES MI
48703-9468
US

V. Phone/Fax

Practice location:
  • Phone: 989-254-6485
  • Fax:
Mailing address:
  • Phone: 989-254-6485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: