Healthcare Provider Details

I. General information

NPI: 1366094534
Provider Name (Legal Business Name): CARSON MILLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date: 01/07/2026
Reactivation Date: 01/12/2026

III. Provider practice location address

1085 S LINDEN RD STE 100
FLINT MI
48532-3416
US

IV. Provider business mailing address

1085 S LINDEN RD STE 100
FLINT MI
48532-3416
US

V. Phone/Fax

Practice location:
  • Phone: 810-262-2350
  • Fax:
Mailing address:
  • Phone: 810-262-2350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201014484
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: