Provider Demographics
NPI:1306600069
Name:LILES, NATHAN EVAN
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:EVAN
Last Name:LILES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 E CENTER ST STE A
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-4261
Mailing Address - Country:US
Mailing Address - Phone:740-382-3185
Mailing Address - Fax:740-387-4238
Practice Address - Street 1:520 E CENTER ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-4260
Practice Address - Country:US
Practice Address - Phone:740-387-3185
Practice Address - Fax:740-387-4238
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.022004225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist