Basic Information
| Provider Information | |||||||||
| NPI: | 1063600427 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TILLEY | ||||||||
| FirstName: | ERIKA | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MS, RD, LDN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 444 STOCKBRIDGE RD | ||||||||
| Address2: | |||||||||
| City: | GREAT BARRINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 012301295 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135288580 | ||||||||
| FaxNumber: | 4135288583 | ||||||||
| Practice Location | |||||||||
| Address1: | 444 STOCKBRIDGE RD | ||||||||
| Address2: | |||||||||
| City: | GREAT BARRINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 012301295 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135288580 | ||||||||
| FaxNumber: | 4135288583 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2007 | ||||||||
| LastUpdateDate: | 03/08/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 2684 | MA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.