Individual
BRENAE MCKENZIE TIDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1301 E LINCOLN RD, IDABEL, OK 74745-7300
(580) 286-7623
Mailing address
5317 NE LINCOLN RD, IDABEL, OK 74745-2431
(580) 236-5069
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
123070
TX
225X00000X
Occupational Therapist
Primary
5689
OK
Other
Enumeration date
09/27/2022
Last updated
09/27/2022
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