Active NPI
Jimmy Dale Brannon, COTA,L
- Occupational Therapy Assistant
- Fordsville, KY
National Provider Identifier
1174720445
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- A3397
- Practice address
- 313 Main
Fordsville, KY 42343 - Phone
- (270) 276-5435
- NPI assigned
- Jun 29, 2007
- Last updated
- Jul 8, 2007
- 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 | A3397 | KY | Primary |
Addresses
Primary practice location
313 Main
Fordsville, KY 42343
Mailing address
813 Broad St
Central, KY 42330
Phone (270) 754-5280
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 |
|---|---|---|---|
| A3397 | KY | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1183075200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1174720445",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "813 BROAD ST",
"city": "CENTRAL",
"state": "KY",
"postal_code": "42330",
"telephone_number": "270-754-5280"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "313 MAIN",
"city": "FORDSVILLE",
"state": "KY",
"postal_code": "42343",
"telephone_number": "270-276-5435"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRANNON",
"first_name": "JIMMY",
"middle_name": "DALE",
"name_prefix": "Mr.",
"credential": "COTA,L",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-06-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "KY",
"license": "A3397",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fordsville, KY
- Karen Marie Aud, SLP
- Extendicare Homes, Inc. (Fordsville Nursing & Rehabilitation Center)
- Fordsville Health Facilities LP (Fordsville Nursing and Rehabilitation Center)
- Fordsville Opco LLC (Fordsville Nursing and Rehabilitation Center)
- Green River District Health Department (Fordsville Elementary School Health Clinic)
- Anita Jo Hall, PTA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.