Provider Demographics
NPI:1457936007
Name:MILLER, AMBER (MT-BC, LPMT)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:MT-BC, LPMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 BARNETT SHOALS RD APT 226
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-7316
Mailing Address - Country:US
Mailing Address - Phone:678-458-3430
Mailing Address - Fax:
Practice Address - Street 1:2758 CLAIRE TER
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-4401
Practice Address - Country:US
Practice Address - Phone:404-827-8794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMUT000242225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist