Provider Demographics
NPI:1972240364
Name:MILLER, BROOKELYN MARIE (AT, ATC)
Entity Type:Individual
Prefix:
First Name:BROOKELYN
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:AT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 N COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:BLANCHARD
Mailing Address - State:MI
Mailing Address - Zip Code:49310-9303
Mailing Address - Country:US
Mailing Address - Phone:616-881-2037
Mailing Address - Fax:
Practice Address - Street 1:315 E WARWICK DR STE 8
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-1083
Practice Address - Country:US
Practice Address - Phone:989-463-2333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-17
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010027092255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer