Jennie Breanne Tidwell, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

OTR2314 Issued in AR

Practice address

821 E Park St
Carlisle, AR 72024-9024

Phone

(870) 552-7110

Fax

(870) 552-7115

NPI assigned

Aug 18, 2009

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

Other names 1

• Breanne Tidwell Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Building Bridges Developmental and Community Services

  • Developmental Disabilities Clinic/Center
  • Lonoke, AR
  • NPI 1649280140
  NPD (past)
• Reaper Therapy, LLC

  • Physical Therapy Clinic/Center
  • Carlisle, AR
  • NPI 1164712725
  NPD (past)

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

{
    "created_epoch": "1250553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1357862400000",
    "number": "1114159688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18 PONDEROSA DR",
            "city": "LONOKE",
            "state": "AR",
            "postal_code": "720863603",
            "telephone_number": "501-920-6808",
            "fax_number": "870-552-7115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "821 E PARK ST",
            "city": "CARLISLE",
            "state": "AR",
            "postal_code": "720249024",
            "telephone_number": "870-552-7110",
            "fax_number": "870-552-7115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIDWELL",
        "first_name": "JENNIE",
        "middle_name": "BREANNE",
        "name_prefix": "Mrs.",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-18",
        "last_updated": "2013-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "AR",
            "license": "OTR2314",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BREANNE",
            "last_name": "TIDWELL",
            "credential": "OTR/L",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Edward J Merritt, MD
• Shala D Neal, OT
• Rebecca Ann Parham, APN
• Reaper Therapy, LLC
• Matthew Bryan Tharp, DPT
• Anna Wagner, RN
• Alex Lauren Walker, RD

• All providers in Carlisle, AR
• Occupational Therapist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2013; 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.