Provider Demographics
NPI:1528192614
Name:TILLER, ELSA BARRON (OTR)
Entity Type:Individual
Prefix:
First Name:ELSA
Middle Name:BARRON
Last Name:TILLER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1171 W TOPAZ
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-6044
Mailing Address - Country:US
Mailing Address - Phone:915-253-8193
Mailing Address - Fax:
Practice Address - Street 1:1171 W TOPAZ
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-6044
Practice Address - Country:US
Practice Address - Phone:915-253-8193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110524225X00000X
UT7924837-4201225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist