Individual
GERLENE-NICOLE TILLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
15855 19 MILE RD, CLINTON TWP, MI 48038-3504
(586) 263-2481
Mailing address
15855 19 MILE RD, CLINTON TWP, MI 48038-3504
(586) 263-2481
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5202008448
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1023114634
—
MI
Enumeration date
04/28/2021
Last updated
01/28/2026
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