Active NPI
Blaire Surley, OTR, CBIS
- Physical Rehabilitation Occupational Therapist
- Fort Worth, TX
National Provider Identifier
1063173995
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Rehabilitation Occupational Therapist
- License
- 117399
- Practice address
- 6601 Harris Pkwy
Fort Worth, TX 76132-6108 - Phone
- (817) 433-9600
- NPI assigned
- Jan 3, 2022
- 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 |
|---|---|---|---|---|
| Physical Rehabilitation Occupational Therapist | 225XP0019X | 117399 | TX | Primary |
Addresses
Primary practice location
6601 Harris Pkwy
Fort Worth, TX 76132-6108
Mailing address
6601 Harris Pkwy
Fort Worth, TX 76132-6108
Phone (817) 433-9600
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 |
|---|---|---|---|
| 117399 | TX | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1641168000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1641168000000",
"number": "1063173995",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6601 HARRIS PKWY",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761326108",
"telephone_number": "817-433-9600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6601 HARRIS PKWY",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761326108",
"telephone_number": "817-433-9600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SURLEY",
"first_name": "BLAIRE",
"credential": "OTR, CBIS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-01-03",
"last_updated": "2022-01-03",
"certification_date": "2022-01-03",
"status": "A"
},
"taxonomies": [
{
"code": "225XP0019X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Physical Rehabilitation",
"state": "TX",
"license": "117399",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.