Provider Demographics
NPI:1275668881
Name:MILLER, AMY KATHLEEN (ATC)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:KATHLEEN
Last Name:MILLER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 REDMOND AVE. LOWER APT
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14216
Mailing Address - Country:US
Mailing Address - Phone:716-888-2939
Mailing Address - Fax:
Practice Address - Street 1:2001 MAIN ST
Practice Address - Street 2:KAC
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14208-1035
Practice Address - Country:US
Practice Address - Phone:716-888-2939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000909-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer