Provider Demographics
NPI:1255651600
Name:TILKA, PATRICE A (LMT)
Entity type:Individual
Prefix:
First Name:PATRICE
Middle Name:A
Last Name:TILKA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2080 SE OAK GROVE BLVD # 8B
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97267-2657
Mailing Address - Country:US
Mailing Address - Phone:503-341-6910
Mailing Address - Fax:
Practice Address - Street 1:2080 SE OAK GROVE BLVD # 8B
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97267-2657
Practice Address - Country:US
Practice Address - Phone:503-341-6910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4023174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist