Active NPI
William Russell Blaylock, OTR
- Occupational Therapist
- Carrollton, TX
National Provider Identifier
1104903020
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 103091
- Practice address
- 1912 E Hebron Pkwy
#104
Carrollton, TX 75007 - Phone
- (972) 492-0383
- Fax
- (972) 492-2074
- NPI assigned
- Nov 1, 2006
- 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 Therapist | 225X00000X | 103091 | TX | Primary |
Addresses
Primary practice location
1912 E Hebron Pkwy
#104
Carrollton, TX 75007
Mailing address
1803 Peach Tree CT
Allen, TX 75002
Phone (972) 492-0383
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1193616000000",
"number": "1104903020",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1803 PEACH TREE CT",
"city": "ALLEN",
"state": "TX",
"postal_code": "75002",
"telephone_number": "972-492-0383",
"fax_number": "972-492-2074"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1912 E HEBRON PKWY",
"address_2": "#104",
"city": "CARROLLTON",
"state": "TX",
"postal_code": "75007",
"telephone_number": "972-492-0383",
"fax_number": "972-492-2074"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLAYLOCK",
"first_name": "WILLIAM",
"middle_name": "RUSSELL",
"name_prefix": "Mr.",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-01",
"last_updated": "2007-10-29",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "TX",
"license": "103091",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Carrollton, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.