Provider Demographics
NPI:1174138960
Name:VANMILL, AUDREY (OT)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:VANMILL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:
Other - Last Name:BREE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5815 STRATHDON WAY
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-2054
Mailing Address - Country:US
Mailing Address - Phone:248-797-6544
Mailing Address - Fax:
Practice Address - Street 1:24111 CIVIC CENTER DR
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-7414
Practice Address - Country:US
Practice Address - Phone:248-349-9595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201001823225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist