Healthcare Provider Details

I. General information

NPI: 1124875216
Provider Name (Legal Business Name): SAMANTHA RAE MUZIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16700 17 MILE RD
CLINTON TOWNSHIP MI
48038-7325
US

IV. Provider business mailing address

16700 17 MILE RD
CLINTON TOWNSHIP MI
48038-7325
US

V. Phone/Fax

Practice location:
  • Phone: 586-228-2300
  • Fax:
Mailing address:
  • Phone: 586-228-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: