Healthcare Provider Details

I. General information

NPI: 1255651600
Provider Name (Legal Business Name): PATRICE A TILKA LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2010
Last Update Date: 06/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 SE OAK GROVE BLVD # 8B
MILWAUKIE OR
97267-2657
US

IV. Provider business mailing address

2080 SE OAK GROVE BLVD # 8B
MILWAUKIE OR
97267-2657
US

V. Phone/Fax

Practice location:
  • Phone: 503-341-6910
  • Fax:
Mailing address:
  • Phone: 503-341-6910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number4023
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: