Provider Demographics
NPI:1740323674
Name:DEBBIE TILTON OTRL INC
Entity type:Organization
Organization Name:DEBBIE TILTON OTRL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:TILTON
Authorized Official - Suffix:
Authorized Official - Credentials:OTRL
Authorized Official - Phone:702-381-1839
Mailing Address - Street 1:11091 KILKERRAN CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-4356
Mailing Address - Country:US
Mailing Address - Phone:702-281-2552
Mailing Address - Fax:
Practice Address - Street 1:11091 KILKERRAN CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89141-4356
Practice Address - Country:US
Practice Address - Phone:702-381-1839
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0127225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV003402253Medicaid
NV100508344OtherMEDICAID GROUP #