Avery Kristie De la Pena, MSOT, OTR

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

118625 Issued in TX

Practice address

18 Scenic Loop Rd # 200D
Boerne, TX 78006-8672

Phone

(830) 755-0098

NPI assigned

Sep 13, 2017

Last updated

May 12, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Avery Kristie Wilson Former name

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dragonfly Kids Therapy

  • Pediatric Occupational Therapist
  • San Antonio, TX
  • NPI 1790674646

  Pediatrics

  Medicare reassignment NPD Authorized official
• Bluebonnet Pediatric Therapy LLC

  • Pediatric Occupational Therapist
  • Boerne, TX
  • NPI 1982358420

  Pediatrics

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1505260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683849600000",
    "number": "1083133813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7631 PONDEROSA PNE",
            "city": "BOERNE",
            "state": "TX",
            "postal_code": "780155141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18 SCENIC LOOP RD # 200D",
            "city": "BOERNE",
            "state": "TX",
            "postal_code": "780068672",
            "telephone_number": "830-755-0098"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1020 Central Pkwy S",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782325021",
            "country_code": "US",
            "telephone_number": "210-798-2273",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DE LA PENA",
        "first_name": "AVERY",
        "middle_name": "KRISTIE",
        "name_prefix": "Mrs.",
        "credential": "MSOT, OTR",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-13",
        "last_updated": "2023-05-12",
        "certification_date": "2023-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "TX",
            "license": "118625",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AVERY",
            "last_name": "WILSON",
            "middle_name": "KRISTIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Delana Rondrici Davis, LCSW
• Rachel Davis
• Eric Randell Day, A.T.C., L.A.T.
• Morgan Lee Day
• Giancarlo De Jesus, PT
• Ricardo De la Pena, RBT
• Jesenia Christiann De Leon
• Melanie Vela De Leon, PHARMD
• Karen Becker Deanda, PHARMD
• David Edgar Deas, DMD, MS

• Pediatric Occupational Therapist in Boerne, TX
• Providers in Boerne, TX by specialty
• Pediatric Occupational Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.