Provider Demographics
NPI:1427212141
Name:TILKINS, AMANDA CATHERINE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:CATHERINE
Last Name:TILKINS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 ELM ST
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:MI
Mailing Address - Zip Code:49285-9652
Mailing Address - Country:US
Mailing Address - Phone:517-745-5115
Mailing Address - Fax:
Practice Address - Street 1:127 ELM ST
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:MI
Practice Address - Zip Code:49285-9652
Practice Address - Country:US
Practice Address - Phone:517-745-5115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5202006643171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor