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General NPI Number Information
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NPI Number | 1346026564
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Entity Type | Individual
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Provider Name | AMANDA MARIE MILLER
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Gender | Female
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Dates
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Enumeration Date | 09/04/2023
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Last Update Date | 09/04/2023
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Provider Practice Location Address
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Address Line | 34 N COLEMAN RD # 3075
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City | CENTEREACH
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State | NY
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Zip | 11720-3075
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Country | US
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Telephone | 631-285-8600
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Fax |
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Provider Business Mailing Address
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Address Line | 50 LAKEVIEW CT
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City | RONKONKOMA
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State | NY
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Zip | 11779-3826
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Country | US
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Telephone | 631-428-0792
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 027292-01
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License Number State | NY
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