Provider Demographics
NPI:1548647217
Name:LIDE, AARON JR (OTR/L)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:LIDE
Suffix:JR
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 NEW GARDEN RD
Mailing Address - Street 2:APT 4310
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-1703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2205 NEW GARDEN RD
Practice Address - Street 2:APT 4310
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-1703
Practice Address - Country:US
Practice Address - Phone:910-354-6558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-01
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9716225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist