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NPI Code Detail

MEDICARE: JOHN ISAAC TILLOTSON BCBA

MEDICARE: JOHN ISAAC TILLOTSON BCBA
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
1103K00000XBehavior Analyst1-18-34205IN

General Provider Information

NPI Number : 1912461435
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN ISAAC TILLOTSON BCBA
Provider Business Mailing Address
First Line : 27777 INKSTER RD STE 100
Second Line :
City : FARMINGTON HILLS
State : MI
Zip : 48334-5312
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5515 N POST RD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46216-1000
Country : US
Telephone Number : 317-812-9711
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/29/2019
Last Update Date : 01/06/2026

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