Active NPI
Fanny Bristol, COTA
- Occupational Therapy Assistant
- Dalhart, TX
National Provider Identifier
1003222530
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 215641
- Practice address
- 115 E Texas Blvd
Dalhart, TX 79022-4319 - Phone
- (806) 244-0015
- NPI assigned
- Jul 3, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 215641 | TX | Primary |
| Occupational Therapy Assistant | 224Z00000X | 933 | NE |
Addresses
Primary practice location
115 E Texas Blvd
Dalhart, TX 79022-4319
Mailing address
PO Box 18
Grand Island, NE 68802-0018
Phone (719) 468-0416
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 933 | NE | MD | Occupational Therapy Assistant |
| 215641 | TX | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1404345600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1764115200000",
"number": "1003222530",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 18",
"city": "GRAND ISLAND",
"state": "NE",
"postal_code": "688020018",
"telephone_number": "719-468-0416"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 E TEXAS BLVD",
"city": "DALHART",
"state": "TX",
"postal_code": "790224319",
"telephone_number": "806-244-0015"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRISTOL",
"first_name": "FANNY",
"credential": "COTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-07-03",
"last_updated": "2025-11-26",
"certification_date": "2025-11-26",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "TX",
"license": "215641",
"primary": true
},
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "NE",
"license": "933",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dalhart, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.