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NPI Code Detail

MEDICARE: DONNA M TILEY OTR L,CHT

MEDICARE: DONNA M TILEY OTR L,CHT
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
1225X00000XOccupational Therapist5036567-4201UT

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2CJ9402OTHERUTRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
19733481002OTHERUTCIGNA
3QM0000057787OTHERUTALTIUS
4870388269BR1OTHERUTEDUCATORS MUTUAL
51108540001OTHERUTCIGNA DMERC
668952OTHERUTPEHP
750365674200001OTHERUTBLUE CROSS BLUE SHIELD
85417OTHERUTDMBA
909-00411OTHERUTUNITED HEALTHCARE

General Provider Information

NPI Number : 1194726786
Entity Type Code : Individual
Provider Name (Legal Business Name) : DONNA M TILEY OTR L,CHT
Provider Business Mailing Address
First Line : 5151 S 900 E
Second Line : #100
City : SALT LAKE CITY
State : UT
Zip : 84117-6657
Country : US
Telephone Number : 801-261-3321
Fax Number : 801-261-5942
Provider Business Practice Location Address
First Line : 5151 S 900 E
Second Line : #100
City : SALT LAKE CITY
State : UT
Zip : 84117-6601
Country : US
Telephone Number : 801-261-3321
Fax Number : 801-261-5942
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2005
Last Update Date : 09/16/2017

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Directions to “ DONNA M TILEY OTR L,CHT” Practice Location

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