Provider Demographics
NPI:1013944305
Name:TILLEY, ADRIANA D (OT)
Entity Type:Individual
Prefix:MRS
First Name:ADRIANA
Middle Name:D
Last Name:TILLEY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MISS
Other - First Name:ADRIANA
Other - Middle Name:D
Other - Last Name:AYUBI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:2020 NE 163RD ST
Mailing Address - Street 2:
Mailing Address - City:N MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-4927
Mailing Address - Country:US
Mailing Address - Phone:954-549-3765
Mailing Address - Fax:305-945-8054
Practice Address - Street 1:2020 NE 163RD ST
Practice Address - Street 2:207
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162
Practice Address - Country:US
Practice Address - Phone:954-549-3765
Practice Address - Fax:305-945-8054
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11746222Q00000X
FLOT11746225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL891648900Medicaid
FLOT11746OtherOCCUPATIONAL THERAPIST
FL003968800Medicaid
FL890689100Medicaid