| Keith Tisdell, | |
|
189 Decker, Kyle, TX 78640-5791 | |
| (954) 328-5436 | |
| Not Available |
| Full Name | Keith Tisdell |
|---|---|
| Gender | Male |
| Speciality | Occupational Therapist In Private Practice |
| Experience | 25 Years |
| Location | 189 Decker, Kyle, Texas |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477550630 | NPI | - | NPPES |
| 887054300 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 225X00000X | Occupational Therapist | 10016 (Florida) | Secondary |
| 225X00000X | Occupational Therapist | 113654 (Florida) | Primary |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Legacy Healthcare Services Inc | 2163339722 | 3431 |
| Provider Name | Legacy Healthcare Services Inc |
|---|---|
| Provider Type | Part B Supplier - Physical/occupational Therapy Group In Private Practice |
| Provider Identifiers | NPI Number: 1336535988 PECOS PAC ID: 2163339722 Enrollment ID: O20150805009289 |
| Mailing Address | Practice Location Address |
|---|---|
| Keith Tisdell, 189 Decker, Kyle, TX 78640-5791 Ph: (954) 328-5436 | Keith Tisdell, 189 Decker, Kyle, TX 78640-5791 Ph: (954) 328-5436 |
Ms. Nicole Anne Brodhead, OTR Occupational Therapist Medicare: Not Enrolled in Medicare Practice Location: 407 S Old Highway 81, Kyle, TX 78640 Phone: 512-504-3035 Fax: 512-504-9287 |
Vachonna S Durall, OTR Occupational Therapist Medicare: Accepting Medicare Assignments Practice Location: 4701 Ratcliffe Dr, Kyle, TX 78640 Phone: 512-920-6400 |
Loren Nicole Moses, OTR/L Occupational Therapist Medicare: Not Enrolled in Medicare Practice Location: 407 S Old Highway 81, Kyle, TX 78640 Phone: 512-504-3035 Fax: 512-504-9287 |
Ms. Susan Jean Nickelson, OTRIL Occupational Therapist Medicare: Not Enrolled in Medicare Practice Location: 407 S Old Highway 81, Kyle, TX 78640 Phone: 512-504-3035 Fax: 512-504-9287 |
Stacy Rayann Bustos, OTR Occupational Therapist Medicare: Not Enrolled in Medicare Practice Location: 132 Ashwood S, Kyle, TX 78640 Phone: 281-851-3086 |
Logan Long, OTR/L Occupational Therapist Medicare: Not Enrolled in Medicare Practice Location: 5980 Kyle Pkwy, Kyle, TX 78640 Phone: 512-308-3015 |
Mrs. Karen Rene Ratcliff, OTR Occupational Therapist Medicare: Not Enrolled in Medicare Practice Location: 407 S Old Highway 81, Kyle, TX 78640 Phone: 210-722-7998 Fax: 512-857-0166 |