Individual
MRS. JENNIE BREANNE TIDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
821 E PARK ST, CARLISLE, AR 72024-9024
(870) 552-7110
(870) 552-7115
Mailing address
18 PONDEROSA DR, LONOKE, AR 72086-3603
(501) 920-6808
(870) 552-7115
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OTR2314
AR
Other
Enumeration date
08/18/2009
Last updated
01/11/2013
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