Provider Demographics
NPI:1225428519
Name:MILLER, MELISSA JOY
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:JOY
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4825 E MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:AU GRES
Mailing Address - State:MI
Mailing Address - Zip Code:48703-9468
Mailing Address - Country:US
Mailing Address - Phone:989-254-6485
Mailing Address - Fax:
Practice Address - Street 1:4825 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:AU GRES
Practice Address - State:MI
Practice Address - Zip Code:48703-9468
Practice Address - Country:US
Practice Address - Phone:989-254-6485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist