Active NPI
Glenna Beth Bornman, OTR
- Occupational Therapist
- Mesquite, TX
National Provider Identifier
1003397639
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 106441
- Practice address
- 3617 O Hare Dr
Mesquite, TX 75150-4539 - Phone
- (972) 284-8600
- NPI assigned
- Aug 22, 2018
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 106441 | TX | Primary |
Addresses
Primary practice location
3617 O Hare Dr
Mesquite, TX 75150-4539
Mailing address
2302 Camp David St
Mesquite, TX 75149-1922
Phone (972) 302-1491
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 106441 | Other | TX | TEXAS STATE BOARD OF PHYSICAL THERAPY AND OCCUPATIONAL THERAPY EXAMINERS |
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 |
|---|---|---|---|
| 106441 | TX | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1534896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1534896000000",
"number": "1003397639",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2302 CAMP DAVID ST",
"city": "MESQUITE",
"state": "TX",
"postal_code": "751491922",
"telephone_number": "972-302-1491"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3617 O HARE DR",
"city": "MESQUITE",
"state": "TX",
"postal_code": "751504539",
"telephone_number": "972-284-8600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BORNMAN",
"first_name": "GLENNA",
"middle_name": "BETH",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-08-22",
"last_updated": "2018-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "TX",
"license": "106441",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TEXAS STATE BOARD OF PHYSICAL THERAPY AND OCCUPATIONAL THERAPY EXAMINERS",
"identifier": "106441",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mesquite, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.