MEDICARE: THERESA TILLMAN

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	342000000X	Transportation Network Company

General Provider Information

NPI Number	:	1871467894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA TILLMAN

Provider Business Mailing Address
First Line	:	3408 MONROE ST
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70607-3202
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3408 MONROE ST
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70607-3202
Country	:	US
Telephone Number	:	337-249-0769
Fax Number	:

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

Provider Enumeration Date	:	10/02/2025
Last Update Date	:	10/02/2025

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Directions to “ THERESA TILLMAN ” Practice Location

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