Provider Demographics
NPI:1386275683
Name:MILLER, AMY RENEE (OTRL)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:RENEE
Last Name:MILLER
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 S SANDSTONE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-8925
Mailing Address - Country:US
Mailing Address - Phone:989-475-1601
Mailing Address - Fax:
Practice Address - Street 1:3394 E JOLLY RD STE C
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-8595
Practice Address - Country:US
Practice Address - Phone:517-253-5160
Practice Address - Fax:517-253-5161
Is Sole Proprietor?:No
Enumeration Date:2020-01-27
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201010492225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist