Healthcare Provider Details

I. General information

NPI: 1437369253
Provider Name (Legal Business Name): GRETCHEN M MILLER ATR-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 05/25/2022
Certification Date: 05/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 BELMONT AVE
YOUNGSTOWN OH
44504-1106
US

IV. Provider business mailing address

2069 OLIVE AVE
LAKEWOOD OH
44107-5707
US

V. Phone/Fax

Practice location:
  • Phone: 330-740-9200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: