Provider Demographics
NPI:1639852437
Name:MANLEY, AMARA D
Entity Type:Individual
Prefix:MS
First Name:AMARA
Middle Name:D
Last Name:MANLEY
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 1:600 N OLD WOODWARD AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-3835
Mailing Address - Country:US
Mailing Address - Phone:989-397-2890
Mailing Address - Fax:
Practice Address - Street 1:600 N OLD WOODWARD AVE STE 101
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-3835
Practice Address - Country:US
Practice Address - Phone:989-397-2890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier