MEDICARE: RACHEL TILLER DEM MIDWIFE

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	176B00000X	Midwife

General Provider Information

NPI Number	:	1316412687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL TILLER DEM MIDWIFE

Provider Business Mailing Address
First Line	:	1196 FORT JEFFERSON AVE
Second Line	:
City	:	GREENVILLE
State	:	OH
Zip	:	45331-1044
Country	:	US
Telephone Number	:	937-548-7894
Fax Number	:

Provider Business Practice Location Address
First Line	:	1196 FT JEFFERSON AVE
Second Line	:
City	:	GREENVILLE
State	:	OH
Zip	:	45331-4533
Country	:	US
Telephone Number	:	937-548-7894
Fax Number	:

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

Provider Enumeration Date	:	10/12/2018
Last Update Date	:	10/12/2018

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Directions to “ RACHEL TILLER DEM MIDWIFE” Practice Location

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