Individual
KELSI TIDBALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1310 COBURG RD STE 5, EUGENE, OR 97401-5200
(541) 345-7532
(541) 345-6692
Mailing address
1310 COBURG RD STE 5, EUGENE, OR 97401-5200
(541) 345-7532
(541) 345-6692
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
16665
OR
Other
Enumeration date
07/10/2014
Last updated
07/10/2014
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