Provider Demographics
NPI:1194726786
Name:TILEY, DONNA M (OTR L,CHT)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:TILEY
Suffix:
Gender:F
Credentials:OTR L,CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 S 900 E
Mailing Address - Street 2:#100
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-6657
Mailing Address - Country:US
Mailing Address - Phone:801-261-3321
Mailing Address - Fax:801-261-5942
Practice Address - Street 1:5151 S 900 E
Practice Address - Street 2:#100
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-6601
Practice Address - Country:US
Practice Address - Phone:801-261-3321
Practice Address - Fax:801-261-5942
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2017-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5036567-4201225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT9733481002OtherCIGNA
UTCJ9402OtherRAILROAD MEDICARE
UTQM0000057787OtherALTIUS
UT870388269BR1OtherEDUCATORS MUTUAL
UT1108540001OtherCIGNA DMERC
UT68952OtherPEHP
UT50365674200001OtherBLUE CROSS BLUE SHIELD
UT5417OtherDMBA
UT09-00411OtherUNITED HEALTHCARE
UT50365674200001OtherBLUE CROSS BLUE SHIELD
UT1108540001Medicare NSC
UT9733481002OtherCIGNA