MEDICARE: MS. ERIKA S TILLEY MS, RD, LDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	2684	MA

General Provider Information

NPI Number	:	1063600427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ERIKA S TILLEY MS, RD, LDN

Provider Business Mailing Address
First Line	:	444 STOCKBRIDGE RD
Second Line	:
City	:	GREAT BARRINGTON
State	:	MA
Zip	:	01230-1295
Country	:	US
Telephone Number	:	413-528-8580
Fax Number	:	413-528-8583

Provider Business Practice Location Address
First Line	:	444 STOCKBRIDGE RD
Second Line	:
City	:	GREAT BARRINGTON
State	:	MA
Zip	:	01230-1295
Country	:	US
Telephone Number	:	413-528-8580
Fax Number	:	413-528-8583

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2007
Last Update Date	:	03/08/2012

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