MEDICARE: LAUREN TIELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT.014804	OH

General Provider Information

NPI Number	:	1093108227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN TIELL

Provider Business Mailing Address
First Line	:	205 W WACKER DR
Second Line	:	SUITE 1020
City	:	CHICAGO
State	:	IL
Zip	:	60606-1216
Country	:	US
Telephone Number	:	312-640-0329
Fax Number	:

Provider Business Practice Location Address
First Line	:	4925 JACKMAN RD
Second Line	:	UNIT 34
City	:	TOLEDO
State	:	OH
Zip	:	43613-3574
Country	:	US
Telephone Number	:	567-318-1000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2015
Last Update Date	:	03/12/2015

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Directions to “ LAUREN TIELL ” Practice Location

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