Active NPI
Kristin Bruner
- Occupational Therapist
- Cocoa, FL
National Provider Identifier
1104363100
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT21708
- Practice address
- 3657 Longbow Rd
Cocoa, FL 32926-4442 - Phone
- (321) 877-8590
- NPI assigned
- Jan 27, 2017
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | OTA9712 | FL | |
| Student in an Organized Health Care Education/Training Program | 390200000X | OTA9712 | FL | |
| Occupational Therapist | 225X00000X | OT21708 | FL | Primary |
Addresses
Primary practice location
3657 Longbow Rd
Cocoa, FL 32926-4442
Mailing address
3657 Longbow Rd
Cocoa, FL 32926-4442
Phone (321) 877-8590
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 |
|---|---|---|---|
| OTA9712 | FL | MD | Occupational Therapy Assistant |
| OT21708 | FL | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1485475200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623888000000",
"number": "1104363100",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3657 LONGBOW RD",
"city": "COCOA",
"state": "FL",
"postal_code": "329264442",
"telephone_number": "321-877-8590"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3657 LONGBOW RD",
"city": "COCOA",
"state": "FL",
"postal_code": "329264442",
"telephone_number": "321-877-8590"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRUNER",
"first_name": "KRISTIN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-01-27",
"last_updated": "2021-06-17",
"certification_date": "2021-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "FL",
"license": "OTA9712",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "FL",
"license": "OTA9712",
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "FL",
"license": "OT21708",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cocoa, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.