Active NPI
Deidre Lynn Fergason, OTR
- Environmental Modification Occupational Therapy Assistant
- Tyler, TX
National Provider Identifier
1215419353
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Environmental Modification Occupational Therapy Assistant
- License
- 103800
- Practice address
- 3505 Old Jacksonville Hwy
Tyler, TX 75703 - Phone
- (903) 368-0357
- NPI assigned
- Sep 5, 2018
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Environmental Modification Occupational Therapy Assistant | 224ZE0001X | 103800 | TX | Primary |
Addresses
Primary practice location
3505 Old Jacksonville Hwy
Tyler, TX 75703
Mailing address
3505 Old Jacksonville Hwy
Tyler, TX 75703
Phone (903) 368-0357
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 |
|---|---|---|---|
| 103800 | TX | MD | Environmental Modification Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1536105600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1536105600000",
"number": "1215419353",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3505 OLD JACKSONVILLE HWY",
"city": "TYLER",
"state": "TX",
"postal_code": "75703",
"telephone_number": "903-368-0357"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3505 OLD JACKSONVILLE HWY",
"city": "TYLER",
"state": "TX",
"postal_code": "75703",
"telephone_number": "903-368-0357"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FERGASON",
"first_name": "DEIDRE",
"middle_name": "LYNN",
"name_prefix": "Mrs.",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-09-05",
"last_updated": "2018-09-05",
"status": "A"
},
"taxonomies": [
{
"code": "224ZE0001X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant, Environmental Modification",
"state": "TX",
"license": "103800",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.