MEDICARE: MILISSA TROMBLEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1871203265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MILISSA TROMBLEY

Provider Business Mailing Address
First Line	:	2521 N ELMS RD
Second Line	:
City	:	FLUSHING
State	:	MI
Zip	:	48433-9423
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1159 S CARNEY DR
Second Line	:
City	:	SAINT CLAIR
State	:	MI
Zip	:	48079-5569
Country	:	US
Telephone Number	:	866-498-3909
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2022
Last Update Date	:	11/28/2022

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Directions to “ MILISSA TROMBLEY ” Practice Location

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