Individual
MS. MICHELE TISDALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
1300 CAMINO SIERRA VIS, 129, SANTA FE, NM 87505-1007
(505) 467-2504
(505) 467-2646
Mailing address
1408 MIRACERROS N, SANTA FE, NM 87505-4018
(505) 467-3000
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
118
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
J4306
—
NM
Enumeration date
03/13/2007
Last updated
07/08/2007
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