NICOLE TIDERENCEL (NPI# 1881114841) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881114841 |
| Entity Type | Individual |
| Full Name | NICOLE TIDERENCEL |
| Credential | CTRS |
| Practice Address |
1291 Stanley Rd Nw Kennesaw GA 30152-4359 |
| Practice Telephone | 7704270147 |
| Mailing Telephone | 7704270147 |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2017-06-21 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 225800000X | Recreation Therapist | 48030 | GA | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Street Address |
1291 STANLEY RD NW |
| City | KENNESAW |
| State | GA |
| Zip Code | 30152-4359 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396833638 | Yassar Jomah Kanawati | Psychiatry & Neurology | 1291 Stanley Rd Nw, Kennesaw, GA 30152-4359 | 2006-10-11 |
| 1932742756 | Helania Savon Hunt | Counselor | 1291 Stanley Rd Nw, Kennesaw, GA 30152-4359 | 2019-10-24 |
| 1316420441 | Tony L Jenkins | Counselor | 1291 Stanley Rd Nw, Kennesaw, GA 30152-4359 | 2018-09-14 |
| 1578046165 | Eman Haddad | Registered Nurse | 1291 Stanley Rd Nw, Kennesaw, GA 30152-4359 | 2018-09-11 |
| 1760965354 | Donna Edwards | Registered Nurse | 1291 Stanley Rd Nw, Kennesaw, GA 30152-4359 | 2018-09-11 |
| 1346729845 | Patrice M Pusha | Recreation Therapist | 1291 Stanley Rd Nw, Kennesaw, GA 30152-4359 | 2018-08-07 |
| 1972081735 | Chukwumeka Micheal Nwanze | Registered Nurse | 1291 Stanley Rd Nw, Kennesaw, GA 30152-4359 | 2018-08-03 |
| 1053899815 | Byrunis Earl Mays Jr. | Licensed Practical Nurse | 1291 Stanley Rd Nw, Kennesaw, GA 30152-4359 | 2018-08-03 |
| 1801374665 | Rubynell Brown | Licensed Practical Nurse | 1291 Stanley Rd Nw, Kennesaw, GA 30152-4359 | 2018-08-03 |
| 1265910020 | Deana Paula Cilento | Licensed Practical Nurse | 1291 Stanley Rd Nw, Kennesaw, GA 30152-4359 | 2018-08-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821647124 | Ashley Dover | Nurse Practitioner | 1300 Ridenour Blvd, Suite 300, Kennesaw, GA 30152 | 2019-09-09 |
| 1205306891 | Lashanda Denise Moore | Nurse Practitioner | 1600 Kennesaw Due West Rd Nw #205, Kennesaw, GA 30152 | 2018-11-27 |
| 1265901094 | Focused Loving Home Care Services LLC | In Home Supportive Care | 2151 Marne Glen Nw, Kennesaw, GA 30152 | 2018-11-22 |
| 1083199152 | Raven Ashley Thomas | Behavioral Analyst | 1619 Collins Rd Nw Ste 500, Kennesaw, GA 30152 | 2018-09-25 |
| 1821592593 | Eseovhe Egborge PC | Clinic/Center | 1600 Kennesaw Due West Rd Nw Ste 205, Kennesaw, GA 30152 | 2018-03-19 |
| 1184143059 | Kennesaw Mountain Dental Associates | Dentist | 1815 Old 41 Hwy, Ste 310, Kennesaw, GA 30152 | 2017-09-12 |
| 1265955983 | Deborah Ruth Stern Compton | Registered Nurse | 1291 Stanley Rd., Kennesaw, GA 30152 | 2017-07-25 |
| 1912452939 | Mak Anesthesia Holdings LLC | Anesthesiology | 1300 Ridenour Blvd., Ste. 300, Kennesaw, GA 30152 | 2016-08-19 |
| 1528430279 | Tineka Nichol Wyckoff | Counselor | 1967 Lake Heights Circle, Kennesaw, GA 30152 | 2015-10-21 |
| 1669753992 | American Current Care Pa | Clinic/Center | 2953 Cobb Parkway, Suite 400, Kennesaw, GA 30152 | 2011-08-31 |
| Find all providers in zip 30152 | ||||
| Taxonomy Code | 225800000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Recreation Therapist |
| A recreation therapist uses recreational activities for intervention in some physical, social or emotional behavior to bring about a desired change in that behavior and promote the growth and development of the patient. |
| Notes: Source: Joel A. DeLisa and Bruce M. Gans, Rehabilitation Medicine: Principles and Practice Second Edition, J.B. Lippincott Company, Philadelphia: 1993, p. 7 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346729845 | Patrice M Pusha | Recreation Therapist | 1291 Stanley Rd Nw, Kennesaw, GA 30152-4359 | 2018-08-07 |
| 1528588571 | Ebony Elbert | Recreation Therapist | 1291 Stanley Rd Nw, Kennesaw, GA 30152-4359 | 2017-06-21 |
| 1609396662 | David Mondecar | Recreation Therapist | 1291 Stanley Rd Nw, Kennesaw, GA 30152-4359 | 2017-06-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215549928 | Athens At Home Wellness Solutions | Recreation Therapist | 1273 E Broad St, Athens, GA 30601-3051 | 2020-08-24 |
| 1447876768 | Rosemary Maines | Recreation Therapist | The Maines Group LLC Dba Maines Health and Wellness, 3461 Jessica Run, Decatur, GA 30034 | 2020-06-23 |
| 1649832452 | Gene Douglas Mcfadden Jr. | Recreation Therapist | 4373 Marjorie Rd, Snellville, GA 30039-6538 | 2019-07-01 |
| 1093160020 | Felicia Raquel Fulton | Recreation Therapist | 741 Erika Ln, Grovetown, GA 30813-8305 | 2016-04-27 |
| 1346505575 | Norma Ray Bivins | Recreation Therapist | 100 Gates Rd, Lizella, GA 31052-3616 | 2012-07-13 |
| 1104058510 | Meghan Patricia Burke | Recreation Therapist | 834 Prince Ave, Athens, GA 30606-2724 | 2009-08-18 |
| 1013128206 | Kenneth Charles Lanthier | Recreation Therapist | 4800 Byers Rd, Alpharetta, GA 30022-7960 | 2007-05-27 |
| 1396822961 | Cindi Meeks | Recreation Therapist | 1742 Wycliffe St, Augusta, GA 30904-5220 | 2006-11-01 |
| 1932218591 | Sharon Denise Whitten | Recreation Therapist | 1 Freedom Way # 276, Augusta, GA 30904-6258 | 2006-08-29 |
| 1184730434 | Todd Michael Spees | Recreation Therapist | 104 Waterford Ct, Bonaire, GA 31005-3624 | 2006-08-21 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.