Provider Demographics
NPI:1518458561
Name:MILLER, VANESSA (AT, ATC)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:AT, ATC
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:RAMIREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3616 47TH ST
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MI
Mailing Address - Zip Code:49419-9723
Mailing Address - Country:US
Mailing Address - Phone:269-370-3529
Mailing Address - Fax:
Practice Address - Street 1:3616 47TH ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MI
Practice Address - Zip Code:49419-9723
Practice Address - Country:US
Practice Address - Phone:269-370-3529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-25
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010007722255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer