| NPI | 1568718104 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA J TILLEY Registered Dietitian 918-497-9764 |
| Organization Subpart ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: OK LD1042) |
| Enumeration Date | 2012-08-01 |
| Last Update Date | 2012-08-15 |