Individual
RHONDA RAE TIDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
500 W 3RD AVE STE 6, CORSICANA, TX 75110-4564
(903) 872-5925
Mailing address
500 W 3RD AVE STE 6, CORSICANA, TX 75110-4564
(903) 872-5925
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
210650
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10191407
—
TX
05
—
210650
—
TX
Enumeration date
07/26/2018
Last updated
07/26/2018
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