Active NPI
Allison Rose Tietjen, OTD
- Occupational Therapist
- Keller, TX
National Provider Identifier
1083348346
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 122838
- Practice address
- 200 Country Brook Dr
Keller, TX 76248-2125 - Phone
- (817) 562-3100
- NPI assigned
- Jul 13, 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 |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 122838 | TX | Primary |
Addresses
Primary practice location
200 Country Brook Dr
Keller, TX 76248-2125
Mailing address
7700 Caribou CT
Fort Worth, TX 76137-5123
Phone (402) 560-7060
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 122838 | TX | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1657670400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1657670400000",
"number": "1083348346",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7700 CARIBOU CT",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761375123",
"telephone_number": "402-560-7060"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 COUNTRY BROOK DR",
"city": "KELLER",
"state": "TX",
"postal_code": "762482125",
"telephone_number": "817-562-3100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TIETJEN",
"first_name": "ALLISON",
"middle_name": "ROSE",
"credential": "OTD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-07-13",
"last_updated": "2022-07-13",
"certification_date": "2022-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "TX",
"license": "122838",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Keller, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 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.