MEDICARE: MELISSA ANN TILLAR OTR

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	225X00000X	Occupational Therapist	31003013A	IN

General Provider Information

NPI Number	:	1336314525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA ANN TILLAR OTR

Provider Business Mailing Address
First Line	:	7232 TARRAGON LN
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46237-3603
Country	:	US
Telephone Number	:	317-883-1671
Fax Number	:

Provider Business Practice Location Address
First Line	:	5391 SHELBY ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-4214
Country	:	US
Telephone Number	:	317-789-1650
Fax Number	:

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

Provider Enumeration Date	:	04/28/2008
Last Update Date	:	04/28/2008

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