Provider Demographics
NPI:1992574719
Name:CRIDER, TIANA
Entity type:Individual
Prefix:
First Name:TIANA
Middle Name:
Last Name:CRIDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3305 OREGON TRL
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1112
Mailing Address - Country:US
Mailing Address - Phone:708-595-5194
Mailing Address - Fax:
Practice Address - Street 1:3305 OREGON TRL
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1112
Practice Address - Country:US
Practice Address - Phone:708-595-5194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist