Active NPI
Jeff Black
- Occupational Therapy Assistant
- Amarillo, TX
National Provider Identifier
1093370736
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 209094
- Practice address
- 6641 W Amarillo Blvd
Amarillo, TX 79106-1755 - Phone
- (806) 352-8800
- NPI assigned
- May 8, 2019
- Sex
- Male
- 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 Therapy Assistant | 224Z00000X | 209094 | TX | Primary |
Addresses
Primary practice location
6641 W Amarillo Blvd
Amarillo, TX 79106-1755
Mailing address
6641 W Amarillo Blvd
Amarillo, TX 79106-1755
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | amarillo@reliant-rehab.com | Direct |
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 |
|---|---|---|---|
| 209094 | TX | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1557273600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1557273600000",
"number": "1093370736",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6641 W AMARILLO BLVD",
"city": "AMARILLO",
"state": "TX",
"postal_code": "791061755"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6641 W AMARILLO BLVD",
"city": "AMARILLO",
"state": "TX",
"postal_code": "791061755",
"telephone_number": "806-352-8800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACK",
"first_name": "JEFF",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-05-08",
"last_updated": "2019-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "TX",
"license": "209094",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "amarillo@reliant-rehab.com",
"affiliation": "N",
"endpointDescription": "email",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "6641 W Amarillo Blvd",
"city": "Amarillo",
"state": "TX",
"country_code": "US",
"postal_code": "791061755",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Amarillo, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.