Provider Demographics
NPI:1992811459
Name:MILLS, AMY
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:MILLS
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 1:1786 SPLIT FORK DR
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-2767
Mailing Address - Country:US
Mailing Address - Phone:813-791-9828
Mailing Address - Fax:
Practice Address - Street 1:2323 CURLEW RD
Practice Address - Street 2:STE 1A
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-9330
Practice Address - Country:US
Practice Address - Phone:727-789-9831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOT4739OtherLICENSE #