Provider Demographics
NPI:1841804663
Name:OUMBOUTTY, TILO ARTHIT-AMARIN (LMT)
Entity Type:Individual
Prefix:
First Name:TILO
Middle Name:ARTHIT-AMARIN
Last Name:OUMBOUTTY
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8209 N NEW ENGLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-2610
Mailing Address - Country:US
Mailing Address - Phone:773-600-6968
Mailing Address - Fax:
Practice Address - Street 1:8307 W GOLF RD # 131
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-1113
Practice Address - Country:US
Practice Address - Phone:773-600-6968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-31
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227017156225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist