Healthcare Provider Details

I. General information

NPI: 1013944305
Provider Name (Legal Business Name): ADRIANA D TILLEY O.T
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ADRIANA D AYUBI O.T.

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 08/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 NE 163RD ST 207
NORTH MIAMI BEACH FL
33162
US

IV. Provider business mailing address

2020 NE 163RD ST
N MIAMI BEACH FL
33162-4927
US

V. Phone/Fax

Practice location:
  • Phone: 954-549-3765
  • Fax: 305-945-8054
Mailing address:
  • Phone: 954-549-3765
  • Fax: 305-945-8054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT11746
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number11746
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: