Taylor Smith Tidwell, OTR

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

20197 Issued in CA

Practice address

2885 Harris St
Eureka, CA 95503-4808

Phone

(707) 443-1627

NPI assigned

Oct 1, 2019

Last updated

Oct 1, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Taylor Leigh Smith Former name

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": "1569888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569888000000",
    "number": "1457992539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 OWENS RD",
            "city": "AUBURN",
            "state": "AL",
            "postal_code": "368302521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2885 HARRIS ST",
            "city": "EUREKA",
            "state": "CA",
            "postal_code": "955034808",
            "telephone_number": "707-443-1627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIDWELL",
        "first_name": "TAYLOR",
        "middle_name": "SMITH",
        "name_prefix": "Mrs.",
        "credential": "OTR",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-01",
        "last_updated": "2019-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "AL",
            "license": "4892",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "KS",
            "license": "17-03531",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "CA",
            "license": "20197",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TAYLOR",
            "last_name": "SMITH",
            "middle_name": "LEIGH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Occupational Therapist in Eureka, CA
• Providers in Eureka, CA by specialty
• Occupational Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2019; 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.