Active NPI
Breanna Marie Trueblood, OTR/L
- Physical Rehabilitation Occupational Therapist
- Bonaire, GA
National Provider Identifier
1073298170
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Rehabilitation Occupational Therapist
- License
- OT008124
- Practice address
- 103 Brandonshire LN
Bonaire, GA 31005-3166 - Phone
- (478) 213-5018
- NPI assigned
- Jun 16, 2023
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OT.6969OT | SC | |
| Physical Rehabilitation Occupational Therapist | 225XP0019X | OT008124 | GA | Primary |
Addresses
Primary practice location
103 Brandonshire LN
Bonaire, GA 31005-3166
Mailing address
103 Brandonshire LN
Bonaire, GA 31005-3166
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 |
|---|---|---|---|
| OT.6969OT | SC | MD | Occupational Therapist |
| OT008124 | GA | MD | Physical Rehabilitation Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1686873600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1693353600000",
"number": "1073298170",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "103 BRANDONSHIRE LN",
"city": "BONAIRE",
"state": "GA",
"postal_code": "310053166"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "103 BRANDONSHIRE LN",
"city": "BONAIRE",
"state": "GA",
"postal_code": "310053166",
"telephone_number": "478-213-5018"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TRUEBLOOD",
"first_name": "BREANNA",
"middle_name": "MARIE",
"credential": "OTR/L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-06-16",
"last_updated": "2023-08-30",
"certification_date": "2023-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "SC",
"license": "OT.6969OT",
"primary": false
},
{
"code": "225XP0019X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Physical Rehabilitation",
"state": "GA",
"license": "OT008124",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bonaire, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.