Individual
MARQUITA NATALYA TIDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
36 BAZEBERRY RD, CORDOVA, TN 38018-7754
(901) 758-0036
Mailing address
9400 GOODMAN RD APT 2707, OLIVE BRANCH, MS 38654-1779
(662) 688-3139
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
3154
TN
224Z00000X
Occupational Therapy Assistant
TA3570
MS
Other
Enumeration date
04/30/2019
Last updated
04/30/2019
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