Individual
MELANIE M TIDMAN
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
M.A., OTR/L
Contact information
Practice address
521 VINEYARD RD NE, ALBUQUERQUE, NM 87113-1055
(505) 344-5756
(505) 341-4810
Mailing address
521 VINEYARD RD NE, ALBUQUERQUE, NM 87113-1055
(505) 344-5756
(505) 341-4810
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
NM 106
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000D1112
—
NM
01
—
26814
PRESBYTERIAN HEALTH PLAN
NM
01
—
NM00E372
BLUE CROSS PROVIDER ID#
NM
Enumeration date
06/18/2006
Last updated
07/09/2007
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