Organization
TIDALHEALTH PEDIATRIC DEVELOPMENT AND THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MALLERY LOWDER (HR DIRECTOR)
(980) 444-2770
Entity
Organization
Contact information
Practice address
30265 COMMERCE DR UNIT 204, MILLSBORO, DE 19966-3595
(704) 799-6824
(704) 799-6825
Mailing address
30265 COMMERCE DR UNIT 204, MILLSBORO, DE 19966-3595
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
225X00000X
Occupational Therapist
Primary
—
—
235Z00000X
Speech-Language Pathologist
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Enumeration date
09/12/2024
Last updated
02/21/2025
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