Provider Demographics
NPI:1790820330
Name:KAISER, AMANDA S (ATC, MS)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:S
Last Name:KAISER
Suffix:
Gender:F
Credentials:ATC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 COUNTY ST
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:MI
Mailing Address - Zip Code:48160-1385
Mailing Address - Country:US
Mailing Address - Phone:734-439-8661
Mailing Address - Fax:
Practice Address - Street 1:200 BIG RED DR
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:MI
Practice Address - Zip Code:48160-1583
Practice Address - Country:US
Practice Address - Phone:734-439-5387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer