Provider Demographics
NPI:1083978381
Name:TILEY, VICTORIA ANN (MSED)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:ANN
Last Name:TILEY
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 JACKSON ST
Mailing Address - Street 2:# 2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-2217
Mailing Address - Country:US
Mailing Address - Phone:718-753-7683
Mailing Address - Fax:
Practice Address - Street 1:74 JACKSON ST
Practice Address - Street 2:# 2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-2217
Practice Address - Country:US
Practice Address - Phone:718-753-7683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist