Provider Demographics
NPI:1740158203
Name:MILLER, DAWN MICHELLE (LMT, CLT)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:MICHELLE
Last Name:MILLER
Suffix:
Gender:F
Credentials:LMT, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12322 N CLIO RD
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420-1093
Mailing Address - Country:US
Mailing Address - Phone:989-975-9181
Mailing Address - Fax:989-975-9181
Practice Address - Street 1:12322 N CLIO RD
Practice Address - Street 2:
Practice Address - City:CLIO
Practice Address - State:MI
Practice Address - Zip Code:48420-1093
Practice Address - Country:US
Practice Address - Phone:989-975-9181
Practice Address - Fax:989-975-9181
Is Sole Proprietor?:No
Enumeration Date:2025-10-27
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501017023225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist