Provider Demographics
NPI:1477215127
Name:TILLER, MARGARET JENEE (LMBT)
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:JENEE
Last Name:TILLER
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13004 ASHEFORD WOODS LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-7845
Mailing Address - Country:US
Mailing Address - Phone:434-944-7702
Mailing Address - Fax:
Practice Address - Street 1:7315 WAVERLY WALK AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-8034
Practice Address - Country:US
Practice Address - Phone:704-209-4515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19217225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist