Healthcare Provider Details

I. General information

NPI: 1619472537
Provider Name (Legal Business Name): AMANDA MARIE REEVES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2018
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 SPRING ST STE 4
PETOSKEY MI
49770-2881
US

IV. Provider business mailing address

316 ANTRIM ST UNIT B
CHARLEVOIX MI
49720-1203
US

V. Phone/Fax

Practice location:
  • Phone: 231-268-0360
  • Fax:
Mailing address:
  • Phone: 231-492-7597
  • 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: