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General NPI Number Information
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NPI Number | 1477215127
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Entity Type | Individual
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Provider Name | DENISE JENEE TILLER LMBT
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Gender | Female
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Dates
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Enumeration Date | 10/11/2021
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 4310 PARK RD APT 102
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City | CHARLOTTE
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State | NC
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Zip | 28209-0006
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Country | US
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Telephone | 704-412-5395
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Fax |
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Provider Business Mailing Address
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Address Line | 13004 ASHEFORD WOODS LN
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City | CHARLOTTE
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State | NC
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Zip | 28278-7845
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Country | US
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Telephone | 434-944-7702
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 12317
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 19217
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License Number State | NC
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