Provider Demographics
NPI:1194309179
Name:MIKAHIEL, AMY (LAT, ATC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:MIKAHIEL
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18738 WOOD GLEN LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-3832
Mailing Address - Country:US
Mailing Address - Phone:832-748-1155
Mailing Address - Fax:
Practice Address - Street 1:18738 WOOD GLEN LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-3832
Practice Address - Country:US
Practice Address - Phone:832-748-1155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-06
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program