Healthcare Provider Details

I. General information

NPI: 1427212141
Provider Name (Legal Business Name): AMANDA CATHERINE TILKINS C.O.T.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2008
Last Update Date: 07/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 ELM ST
STOCKBRIDGE MI
49285-9652
US

IV. Provider business mailing address

127 ELM ST
STOCKBRIDGE MI
49285-9652
US

V. Phone/Fax

Practice location:
  • Phone: 517-745-5115
  • Fax:
Mailing address:
  • Phone: 517-745-5115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number5202006643
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: