Tina Marie Black

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

OT003199 Issued in GA

Practice address

4502 Summer Gate CT
Gainesville, GA 30506-4677

Phone

(770) 378-5986

Fax

(770) 536-0346

NPI assigned

Nov 9, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Black'S Pediatric Therapy, Inc.

  • Pediatric Occupational Therapist
  • Gainesville, GA
  • NPI 1477754067

  Pediatrics

  NPD (past) Authorized official
• Essential Therapy Services, Inc.

  • Occupational Therapist
  • Cumming, GA
  • NPI 1508077991
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1013087428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4502 SUMMER GATE CT",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305064677",
            "telephone_number": "770-378-5986",
            "fax_number": "770-536-0346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4502 SUMMER GATE CT",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305064677",
            "telephone_number": "770-378-5986",
            "fax_number": "770-536-0346"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "TINA",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-09",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "GA",
            "license": "OT003199",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "307327",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "10038361",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kayleigh Dyches Biskup, FNP-C
• Cheryl Lynn Bittel, APRN
• Jeffry Joseph Bizon, MD
• Emily Anne Black, MD
• Steven Edward Black, M.D.
• Wiley S Black, MD
• Black'S Pediatric Therapy, Inc.
• Julianne Blackburn, PA
• Brianna Blackwell
• Kristen H Blair, AGACNP

• Pediatric Occupational Therapist in Gainesville, GA
• Providers in Gainesville, GA by specialty
• Pediatric Occupational Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.