Active NPI
Stephanie Marie Rudisill, OTR
- Occupational Therapist
- Park City, UT
National Provider Identifier
1063633964
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 109688
- Practice address
- 1640 Redstone Center Dr
Suite 200
Park City, UT 84098-7605 - Phone
- (214) 575-9820
- Fax
- (214) 575-9846
- NPI assigned
- May 1, 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 | 109688 | TX | Primary |
Addresses
Primary practice location
1640 Redstone Center Dr
Suite 200
Park City, UT 84098-7605
Mailing address
703 Northill Dr
Richardson, TX 75080-5018
Phone (972) 238-7192
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 |
|---|---|---|---|
| 109688 | TX | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177977600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1063633964",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "703 NORTHILL DR",
"city": "RICHARDSON",
"state": "TX",
"postal_code": "750805018",
"telephone_number": "972-238-7192",
"fax_number": "972-238-7192"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1640 REDSTONE CENTER DR",
"address_2": "SUITE 200",
"city": "PARK CITY",
"state": "UT",
"postal_code": "840987605",
"telephone_number": "214-575-9820",
"fax_number": "214-575-9846"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUDISILL",
"first_name": "STEPHANIE",
"middle_name": "MARIE",
"name_prefix": "Mrs.",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "TX",
"license": "109688",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Park City, UT
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.