Active NPI
Nicole Anne Brodhead, OTR
- Occupational Therapist
- Kyle, TX
National Provider Identifier
1023364023
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 114832
- Practice address
- 407 S Old Highway 81
Kyle, TX 78640-5310 - Phone
- (512) 504-3035
- Fax
- (512) 504-9287
- NPI assigned
- Jul 27, 2012
- Last updated
- Aug 14, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 114832 | TX | Primary |
Addresses
Primary practice location
407 S Old Highway 81
Kyle, TX 78640-5310
Mailing address
111 W. Anderson LN C-100
Austin, TX 78752
Phone (512) 451-0961
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 |
|---|---|---|---|
| 114832 | TX | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Language & Movement | Past | Accepting new patients | |
| Total Child Therapy Center | Past | Accepting new patients | |
| Total Child Therapy Home Health PLLC | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Developmental Disabilities Clinic/Center
- Austin, TX
- NPI 1215034426
-
- Pediatric Occupational Therapist
- Kyle, TX
- NPI 1487976528
-
dba Total Child Therapy Home Health
- Home Health Agency
- Kyle, TX
- NPI 1689915795
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1343347200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1407974400000",
"number": "1023364023",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111 W. ANDERSON LN C-100",
"city": "AUSTIN",
"state": "TX",
"postal_code": "78752",
"telephone_number": "512-451-0961",
"fax_number": "512-451-9745"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "407 S OLD HIGHWAY 81",
"city": "KYLE",
"state": "TX",
"postal_code": "786405310",
"telephone_number": "512-504-3035",
"fax_number": "512-504-9287"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRODHEAD",
"first_name": "NICOLE",
"middle_name": "ANNE",
"name_prefix": "Ms.",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-07-27",
"last_updated": "2014-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "TX",
"license": "114832",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kyle, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.