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Individual

LAUREN MARIE TIDMORE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
OTR

Contact information

Practice address
11330 FARRAH, AUSTIN, TX 78748-1959
(512) 280-2030
Mailing address
11330 FARRAH, AUSTIN, TX 78748-1959

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
112180
TX

Other

Enumeration date
10/09/2015
Last updated
10/09/2015
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