MEDICARE: TIHELA BRILLER

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	224Z00000X	Occupational Therapy Assistant	46TA09123100	NJ

General Provider Information

NPI Number	:	1669824348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIHELA BRILLER

Provider Business Mailing Address
First Line	:	110 HILLSIDE BLVD
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-3394
Country	:	US
Telephone Number	:	732-813-4263
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 HILLSIDE BLVD
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-3394
Country	:	US
Telephone Number	:	732-813-4263
Fax Number	:

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

Provider Enumeration Date	:	07/06/2016
Last Update Date	:	07/06/2016

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