Provider Demographics
NPI:1821490202
Name:TILLERY, JODI CARNAHAN (RRT)
Entity Type:Individual
Prefix:MS
First Name:JODI
Middle Name:CARNAHAN
Last Name:TILLERY
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 AVIATION PLZ
Mailing Address - Street 2:SUITE C
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-5529
Mailing Address - Country:US
Mailing Address - Phone:501-525-2770
Mailing Address - Fax:
Practice Address - Street 1:190 AVIATION PLZ
Practice Address - Street 2:SUITE C
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-5529
Practice Address - Country:US
Practice Address - Phone:501-525-2770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARRCP-3581227900000X, 2279P1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279P1005XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredPulmonary Rehabilitation
No227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered