NICOLE TIDERENCEL CTRS
NPI 1881114841
Recreation Therapist in Kennesaw, GA

Q: What is the provider's specialty?

The provider's specialty is Recreation Therapist with taxonomy code 225800000X.

Active since June 21, 2017

1291 STANLEY RD NW, KENNESAW, GA 30152(770) 427-0147 Get Directions Write a Review

NPPES record last updated: June 21, 2017. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Table of Contents

NPI Profile Information
Primary Taxonomy
Other Providers Same Location
Frequently Asked Questions

Individual
Female
Recreation Therapist

About NICOLE TIDERENCEL

This page provides the complete NPI Profile along with additional information for Nicole Tiderencel, a provider established in Kennesaw, Georgia with a medical specialization in Recreation Therapist. The healthcare provider is registered in the NPI registry with number 1881114841 assigned on June 2017. The practitioner's primary taxonomy code is 225800000X with license number 48030 (GA). The provider is registered as an individual and her NPI record was last updated 9 years ago.

NPI: 1881114841 Verify this NPI
Provider Name: NICOLE TIDERENCEL CTRS
Gender: Female
Entity Type: Individual
Location Address: 1291 STANLEY RD NW KENNESAW, GA 30152
Location Phone: (770) 427-0147
Mailing Address: 1291 STANLEY RD NW KENNESAW, GA 30152
Mailing Phone: (770) 427-0147
Is Sole Proprietor?: No
Enumeration Date: 06-21-2017
Last Update Date: 06-21-2017
Code Navigator

Location Map

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification: Recreation Therapist
Taxonomy Code: 225800000X
Type: Respiratory, Developmental, Rehabilitative and Restorative Service Providers
License No.: 48030
License State: GA
Taxonomy Description: 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.