Individual
MS. BETTY GAIL TILLEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC, LAT
Contact information
Practice address
1111 N GLENSTONE AVE, SPRINGFIELD, MO 65802-2125
(417) 865-2815
(417) 575-5494
Mailing address
741 S GRANDVIEW AVE, SPRINGFIELD, MO 65802-3013
(417) 864-7854
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
00061
MO
Other
Enumeration date
07/01/2006
Last updated
07/08/2007
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