Most Relevant Information
Provider Data
| NPI Number: | 1003419425 |
| Provider Name: | MICHELLE LYNN TILLERY |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 11/18/2020 |
| Last Updated: | 11/18/2020 |
Provider Practice Location
210 JUDY DR
SUTTER CREEK
CA
956854020
Practice Location Phone/Fax
| Phone: | 9166183790 |
| Fax: |
Provider Mailing Location
6400 TUPELO DR
CITRUS HEIGHTS
CA
956211741
Provider Mailing Phone/Fax
| Phone: | 9167293098 |
| Fax: |