Active NPI
Brenda Leigh Kirchenbauer, OTR
- Occupational Therapist
- Ponca City, OK
National Provider Identifier
1053437558
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 641
- Practice address
- 1900 N 14TH St
Ponca City, OK 74601-2035 - Phone
- (580) 765-0518
- Fax
- (580) 765-0203
- NPI assigned
- Mar 22, 2007
- 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 | 641 | OK | Primary |
Addresses
Primary practice location
1900 N 14TH St
Ponca City, OK 74601-2035
Mailing address
4765 E Prospect Ave
Ponca City, OK 74604-5763
Phone (580) 762-8199
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 |
|---|---|---|---|
| 641 | OK | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174521600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1053437558",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4765 E PROSPECT AVE",
"city": "PONCA CITY",
"state": "OK",
"postal_code": "746045763",
"telephone_number": "580-762-8199"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1900 N 14TH ST",
"city": "PONCA CITY",
"state": "OK",
"postal_code": "746012035",
"telephone_number": "580-765-0518",
"fax_number": "580-765-0203"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIRCHENBAUER",
"first_name": "BRENDA",
"middle_name": "LEIGH",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "OK",
"license": "641",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ponca City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.