Healthcare Provider Details

I. General information

NPI: 1104021153
Provider Name (Legal Business Name): AMY E MILLER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 SARA AVE
GALION OH
44833-3048
US

IV. Provider business mailing address

1415 SARA AVE
GALION OH
44833-3048
US

V. Phone/Fax

Practice location:
  • Phone: 614-592-5223
  • Fax:
Mailing address:
  • Phone: 614-592-5223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA-03506
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: