Angela Mary Tidwell, OT

Primary specialty

Hand Occupational TherapistTaxonomy code 225XH1200X

License

8534 Issued in NC

Practice address

136 Corporate Park Dr
Mooresville, NC 28117-6959

Phone

(704) 360-2796

NPI assigned

May 9, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1525824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525824000000",
    "number": "1063901668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 STAMFORD CT",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281177042",
            "telephone_number": "407-766-8747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "136 CORPORATE PARK DR",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281176959",
            "telephone_number": "704-360-2796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIDWELL",
        "first_name": "ANGELA",
        "middle_name": "MARY",
        "credential": "OT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-09",
        "last_updated": "2018-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XH1200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Hand",
            "state": "NC",
            "license": "8534",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Hand Occupational Therapist in Mooresville, NC
• Providers in Mooresville, NC by specialty
• Hand Occupational Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.