Individual
KATHERINE TILLMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8119 N MULBERRY ST, TAMPA, FL 33604-3443
(813) 410-6159
Mailing address
8119 N MULBERRY ST, TAMPA, FL 33604-3443
(813) 410-6159
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
6906834
FL
335E00000X
Prosthetic/Orthotic Supplier
CL1189677
FL
Other
Enumeration date
01/11/2016
Last updated
01/27/2025
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