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General NPI Number Information
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NPI Number | 1962299941
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Entity Type | Individual
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Provider Name | AUTUMN LOUISE LILLARD
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Gender | Female
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Dates
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Enumeration Date | 04/22/2025
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Last Update Date | 04/22/2025
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Provider Practice Location Address
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Address Line | 8922 S MEMORIAL DR STE B
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City | TULSA
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State | OK
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Zip | 74133-4341
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Country | US
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Telephone | 918-615-3339
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Fax |
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Provider Business Mailing Address
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Address Line | 1025 E 60TH ST APT 623
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City | TULSA
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State | OK
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Zip | 74105-8305
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Country | US
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Telephone | 918-829-7563
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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 | 195550
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License Number State | OK
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