Individual provider Active NPI

Adrianne B Scanlon, OTR

  • Pediatric Occupational Therapist
  • Killeen, TX
National Provider Identifier
1134369804
Registry record updated Mar 6, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Occupational TherapistTaxonomy code 225XP0200X
License
112989 Issued in TX
Practice address
605 Donne
Killeen, TX 76541
Phone
(254) 634-8505
Fax
(254) 519-3477
NPI assigned
Feb 20, 2009
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 6, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 112989 TX
Pediatric Occupational Therapist 225XP0200X 112989 TX Primary

Addresses

Primary practice location

605 Donne
Killeen, TX 76541

Mailing address

1102 Winkler Ave
Killeen, TX 76542
Phone (254) 634-8505

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241023002977 TX Practitioner - Occupational Therapist in Private Practice 3678006053 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
112989TXMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Barr Physical Therapy, P.C. Occupational Therapist CurrentSince Sep 1, 2024 Accepting new patients
Barr Physical Therapy, P.C. Occupational Therapist Past Accepting new patients
San Luis Walk-in Clinic, Inc. PastSince Sep 1, 2024 Accepting new patients

Locations

1102 Winkler Ave
Killeen, TX 76542
Phone (254) 634-8505

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/11823/brand/2/csg/41/fhir/r4

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1235088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1362528000000",
    "number": "1134369804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1102 WINKLER AVE",
            "city": "KILLEEN",
            "state": "TX",
            "postal_code": "76542",
            "telephone_number": "254-634-8505",
            "fax_number": "254-519-3477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 DONNE",
            "city": "KILLEEN",
            "state": "TX",
            "postal_code": "76541",
            "telephone_number": "254-634-8505",
            "fax_number": "254-519-3477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCANLON",
        "first_name": "ADRIANNE",
        "middle_name": "B",
        "credential": "OTR",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-02-20",
        "last_updated": "2013-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "TX",
            "license": "112989",
            "primary": false
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "TX",
            "license": "112989",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Killeen, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.