Julie Ann Tinnon, COTA/L
Individual provider Active NPI Occupational Therapy Assistant · South Roxana, IL
NPI 1083975155 · NPPES record last updated Jun 5, 2012
Key facts
- NPI
- 1083975155
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapy Assistant 224Z00000X
- License
- 2009035429 (MO)
- Practice address
- 203 Pennsylvania Ave
South Roxana, IL 62087-1646 - Phone
- (618) 225-7094
- NPI assigned
- Jun 5, 2012
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2009035429 | MO | MD | Occupational Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 2009035429 | MO | Yes |
Addresses
Primary practice location
203 Pennsylvania Ave
South Roxana, IL 62087-1646
Mailing address
203 Pennsylvania Ave
South Roxana, IL 62087-1646
Other providers in South Roxana, IL
All providers in South Roxana, IL · Occupational Therapy Assistant in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 5, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.