Active NPI
Kimberly Gresham, OTR
- Occupational Therapist
- Tyler, TX
National Provider Identifier
1063899862
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 114603
- Practice address
- 1001 WSW Loop 323
Tyler, TX 75701-9416 - Phone
- (903) 509-1313
- Fax
- (903) 509-1383
- NPI assigned
- Apr 30, 2015
- Sex
- Female
- 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 | 114603 | TX | Primary |
Addresses
Primary practice location
1001 WSW Loop 323
Tyler, TX 75701-9416
Mailing address
612 E Twin Creeks TRL
Troup, TX 75789-6708
Phone (936) 556-3756
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 |
|---|---|---|---|
| 114603 | TX | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| East Texas Pediatric Rehabilitation Associates Inc | Past | Accepting new patients | |
| Bo Keeling, PLLC | Occupational Therapist | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Comprehensive Outpatient Rehabilitation Facility (CORF)
- Tyler, TX
- NPI 1871654244
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1430352000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1430352000000",
"number": "1063899862",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "612 E TWIN CREEKS TRL",
"city": "TROUP",
"state": "TX",
"postal_code": "757896708",
"telephone_number": "936-556-3756"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 WSW LOOP 323",
"city": "TYLER",
"state": "TX",
"postal_code": "757019416",
"telephone_number": "903-509-1313",
"fax_number": "903-509-1383"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRESHAM",
"first_name": "KIMBERLY",
"credential": "OTR",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-04-30",
"last_updated": "2015-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "TX",
"license": "114603",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.