Provider Demographics
NPI:1669742151
Name:MILLER, AMANDA ELAINE (OTR)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:ELAINE
Last Name:MILLER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9505 NORTHPOINTE BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-3799
Mailing Address - Country:US
Mailing Address - Phone:936-827-1408
Mailing Address - Fax:
Practice Address - Street 1:9505 NORTHPOINTE BLVD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-3799
Practice Address - Country:US
Practice Address - Phone:936-827-1408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-30
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111021225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist