Healthcare Provider Details

I. General information

NPI: 1265270144
Provider Name (Legal Business Name): ASHLEY TILLERY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2024
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 BELMONT AVE
YOUNGSTOWN OH
44504-1006
US

IV. Provider business mailing address

1 TRESSEL WAY APT 8F
YOUNGSTOWN OH
44555-9703
US

V. Phone/Fax

Practice location:
  • Phone: 330-746-7211
  • Fax:
Mailing address:
  • Phone: 330-941-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: