Active NPI
Lauren N Bush
- Pediatric Occupational Therapist
- Tyler, TX
National Provider Identifier
1083925077
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Occupational Therapist
- License
- 110902
- Practice address
- 4801 Troup Hwy
Suite 800
Tyler, TX 75703-2356 - Phone
- (903) 939-2800
- NPI assigned
- Jun 24, 2010
- 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 |
|---|---|---|---|---|
| Pediatric Occupational Therapist | 225XP0200X | 110902 | TX | Primary |
Addresses
Primary practice location
4801 Troup Hwy
Suite 800
Tyler, TX 75703-2356
Mailing address
2162 Rana Park
Flint, TX 75762-8840
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 149984001 | Medicaid | TX |
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 |
|---|---|---|---|
| 110902 | TX | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1277337600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1277337600000",
"number": "1083925077",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2162 RANA PARK",
"city": "FLINT",
"state": "TX",
"postal_code": "757628840"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4801 TROUP HWY",
"address_2": "SUITE 800",
"city": "TYLER",
"state": "TX",
"postal_code": "757032356",
"telephone_number": "903-939-2800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUSH",
"first_name": "LAUREN",
"middle_name": "N",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-06-24",
"last_updated": "2010-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "225XP0200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Pediatrics",
"state": "TX",
"license": "110902",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "149984001",
"state": "TX"
}
],
"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 Jun 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.