Active NPI
Dalles Raydell Black
- Occupational Therapy Assistant
- Tampa, FL
National Provider Identifier
1245797794
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 16690
- Practice address
- 15002 Hutchison Rd
Tampa, FL 33625-5502 - Phone
- (813) 960-1969
- NPI assigned
- Feb 20, 2019
- Last updated
- Feb 20, 2019
- 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 |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 16690 | FL | Primary |
Addresses
Primary practice location
15002 Hutchison Rd
Tampa, FL 33625-5502
Mailing address
2294 Primrose LN Apt 1606
Clearwater, FL 33763-1059
Phone (407) 731-7695
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 |
|---|---|---|---|
| 16690 | FL | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1550620800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1550620800000",
"number": "1245797794",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2294 PRIMROSE LN APT 1606",
"city": "CLEARWATER",
"state": "FL",
"postal_code": "337631059",
"telephone_number": "407-731-7695"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15002 HUTCHISON RD",
"city": "TAMPA",
"state": "FL",
"postal_code": "336255502",
"telephone_number": "813-960-1969"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACK",
"first_name": "DALLES",
"middle_name": "RAYDELL",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-02-20",
"last_updated": "2019-02-20",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "FL",
"license": "16690",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tampa, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.