Provider Demographics
NPI:1871873224
Name:WILLEY, AMELIA GRACE
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:GRACE
Last Name:WILLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:699 WINNETKA AVE. NORTH
Mailing Address - Street 2:202
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427
Mailing Address - Country:US
Mailing Address - Phone:651-235-4722
Mailing Address - Fax:
Practice Address - Street 1:699 WINNETKA AVENUE NORTH
Practice Address - Street 2:202
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55427
Practice Address - Country:US
Practice Address - Phone:651-235-4722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist