Provider Demographics
NPI:1437702990
Name:MILLER, SARAH GRACE (MS, BC-DMT)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:GRACE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS, BC-DMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1822 KREISER ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-4022
Mailing Address - Country:US
Mailing Address - Phone:517-899-8576
Mailing Address - Fax:
Practice Address - Street 1:2505 ARDMORE ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-4924
Practice Address - Country:US
Practice Address - Phone:616-559-1054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBC-DMT-1343225600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist