Individual
DEBRA TIDMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
30 SPRINGCREST CT, GREENVILLE, SC 29607-4034
(864) 528-5547
Mailing address
121 BALDWIN CREEK WAY, SIMPSONVILLE, SC 29680-7412
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
3401
SC
Other
Enumeration date
02/07/2015
Last updated
02/07/2015
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