Provider Demographics
NPI:1255094959
Name:TILSON, FIONA MARY
Entity Type:Individual
Prefix:
First Name:FIONA
Middle Name:MARY
Last Name:TILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6240 SOUTHWOOD AVE APT 2E
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-3234
Mailing Address - Country:US
Mailing Address - Phone:847-770-5993
Mailing Address - Fax:
Practice Address - Street 1:1001 S KIRKWOOD RD STE 150
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-7251
Practice Address - Country:US
Practice Address - Phone:314-821-7554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021038838225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist