Individual provider Active NPI

Angela Custer, OTR

  • Occupational Therapist
  • Edmond, OK
National Provider Identifier
1194212209
Registry record updated May 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
5917 Issued in OK
Practice address
14715 Bristol Park Blvd
Edmond, OK 73013-1894
Phone
(405) 840-1686
NPI assigned
Apr 16, 2018
Last updated
May 2, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 2, 2024

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 5917 OK Primary
Occupational Therapist 225X00000X 117790 TX

Addresses

Primary practice location

14715 Bristol Park Blvd
Edmond, OK 73013-1894

Mailing address

25018 Oakhurst Dr
Spring, TX 77386-2722
Phone (281) 364-9695

Other practice location 1

25018 Oakhurst Dr
Spring, TX 77386-2722
Phone (281) 364-9695

Other practice location 2

6800 NW 39th Expy
Bethany, OK 73008-2513
Phone (405) 789-6711

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

LicenseStateTypeSpecialty
5917OKMDCounselor
117790TXMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Sensational Kids Inc CurrentSince May 7, 2024 Accepting new patients
Sensational Kids PastSince May 7, 2024 Accepting new patients
Pathfinder Pediatrics Home Care, LLC PastSince Mar 3, 2024 Accepting new patients

Locations

14715 Bristol Park Blvd
Edmond, OK 73013
Phone (405) 840-1686

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1523836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714608000000",
    "number": "1194212209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25018 OAKHURST DR",
            "city": "SPRING",
            "state": "TX",
            "postal_code": "773862722",
            "telephone_number": "281-364-9695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14715 BRISTOL PARK BLVD",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730131894",
            "telephone_number": "405-840-1686"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "25018 Oakhurst Dr",
            "address_purpose": "LOCATION",
            "city": "Spring",
            "state": "TX",
            "postal_code": "773862722",
            "country_code": "US",
            "telephone_number": "281-364-9695",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6800 NW 39th Expy",
            "address_purpose": "LOCATION",
            "city": "Bethany",
            "state": "OK",
            "postal_code": "730082513",
            "country_code": "US",
            "telephone_number": "405-789-6711",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CUSTER",
        "first_name": "ANGELA",
        "credential": "OTR",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-16",
        "last_updated": "2024-05-02",
        "certification_date": "2024-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "OK",
            "license": "5917",
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "TX",
            "license": "117790",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edmond, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.