Individual
JASELYN HARRISON TIDMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
209 W COLLEGE ST, COLUMBIANA, AL 35051-9724
(205) 210-4980
Mailing address
176 HIGHWAY 61, COLUMBIANA, AL 35051-5258
(205) 566-2798
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5218
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5218
OCCUPATIONAL THERAPY LICENSE NUMBER
AL
Enumeration date
07/28/2022
Last updated
07/28/2022
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