IndividualActive
Nicole Tiderencel, CTRS
NPI 1881114841 · Recreation Therapist · Kennesaw, GA
Provider details
- NPI number
- 1881114841
- Entity type
- Individual
- Primary specialty
- Recreation TherapistRespiratory, Developmental, Rehabilitative and Restorative Service Providers
- Credential
- CTRS
- Sex
- Female
- Sole proprietor
- No
- License
- 48030 (GA)
Specialties & taxonomies
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Practice location
1291 Stanley Rd Nw
Kennesaw, GA 30152-4359
Phone: (770) 427-0147
Approximate (ZIP-level) locationGet directions
Mailing address
1291 Stanley Rd Nw
Kennesaw, GA 30152-4359
Registry dates
- Enumerated
- 2017-06-21
- Last updated
- 2017-06-21
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.