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1740772219
CHARLENE TIDWELL
SAN ANTONIO, TX
NPI
1740772219
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
224Z00000X Occupational Therapy Assistant
(Licence: TX 213729)
Enumeration Date
2018-05-31
Last Update Date
2018-05-31
Business Address
CHARLENE TIDWELL COTA/L
3201 CHERRY RIDGE ST STE D400
SAN ANTONIO, TX 78230-4820
Phone number: 210-692-0222
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Mailing Address
CHARLENE TIDWELL COTA/L
3711 MEDICAL DR APT 2537
SAN ANTONIO, TX 78229-2349
Phone number: 575-915-5243
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