Jaselyn Harrison Tidmore, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

5218 Issued in AL

Practice address

209 W College St
Columbiana, AL 35051-9724

Phone

(205) 210-4980

NPI assigned

Jul 28, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AL

Enrollment records 1

Specialty

Occupational Therapist in Private Practice

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

PT Solutions of Montgomery LLCGroup PAC ID 6305891037, 10 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• PT Solutions of Montgomery, LLC

  • Physical Therapist
  • Montgomery, AL
  • NPI 1073558086

  Single Specialty

  Medicare reassignment Care Compare group NPD
• PT Solutions of Montgomery, LLC

  • Physical Therapist
  • Columbiana, AL
  • NPI 1619636495

  Occupational Therapist

  NPD

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

{
    "created_epoch": "1658966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658966400000",
    "number": "1194451468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "176 HIGHWAY 61",
            "city": "COLUMBIANA",
            "state": "AL",
            "postal_code": "350515258",
            "telephone_number": "205-566-2798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 W COLLEGE ST",
            "city": "COLUMBIANA",
            "state": "AL",
            "postal_code": "350519724",
            "telephone_number": "205-210-4980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIDMORE",
        "first_name": "JASELYN",
        "middle_name": "HARRISON",
        "credential": "OTR/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-07-28",
        "last_updated": "2022-07-28",
        "certification_date": "2022-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Occupational Therapist",
            "state": "AL",
            "license": "5218",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OCCUPATIONAL THERAPY LICENSE NUMBER",
            "identifier": "5218",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• State of Alabama
• David A Stull, DC
• Kayla Landefeld Tennyson, NP
• Robert Lee Thornburg, DMD
• Don Max Thrower, C.R.N.P.
• Jamie M Tillman, PHARMD
• Lyauro Alicia Venegas Johnson
• Terrica Dean Vincent
• Jennifer Weldon
• Donna Harvey Williamson, PHARMACIST

• Occupational Therapist in Columbiana, AL
• Providers in Columbiana, AL by specialty
• Occupational Therapist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.