Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | SS0000707 | FL |
NPI | 1073959540 |
---|---|
Provider Name | Dr. Amy Michele Milam |
First Address | Brandon, FL 33511-4730 |
Second Address | Brandon, FL 33511-4730 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2013 |
Last Update Date | 10/05/2013 |