Active NPI
Bruce Coral Richardson, OTR/L
- Occupational Therapist
- Eden, NC
National Provider Identifier
1033420732
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 4607
- Practice address
- 272 Glenrobin Dr
Eden, NC 27288-8094 - Phone
- (336) 589-8396
- NPI assigned
- Jun 28, 2010
- Sex
- Male
- Sole proprietor
- Yes
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 | 4607 | NC | Primary |
Addresses
Primary practice location
272 Glenrobin Dr
Eden, NC 27288-8094
Mailing address
272 Glenrobin Dr
Eden, NC 27288-8094
Phone (336) 589-8396
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4607 | NC | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1277683200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1277683200000",
"number": "1033420732",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "272 GLENROBIN DR",
"city": "EDEN",
"state": "NC",
"postal_code": "272888094",
"telephone_number": "336-589-8396"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "272 GLENROBIN DR",
"city": "EDEN",
"state": "NC",
"postal_code": "272888094",
"telephone_number": "336-589-8396"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RICHARDSON",
"first_name": "BRUCE",
"middle_name": "CORAL",
"name_prefix": "Mr.",
"credential": "OTR/L",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-06-28",
"last_updated": "2010-06-28",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NC",
"license": "4607",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eden, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.