Active NPI
David J Reis, OTR
- Pediatric Occupational Therapist
- Shiprock, NM
National Provider Identifier
1326108218
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Occupational Therapist
- License
- 1762
- Practice address
- US Hwy 64 Old High School Road
Shiprock, NM 87420 - Phone
- (505) 368-5163
- Fax
- (505) 368-5502
- NPI assigned
- Dec 11, 2006
- 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 |
|---|---|---|---|---|
| Pediatric Occupational Therapist | 225XP0200X | 1762 | NM | Primary |
Addresses
Primary practice location
US Hwy 64 Old High School Road
Shiprock, NM 87420
Mailing address
31277 CR L
Mancos, CO 81328
Phone (505) 649-2045
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 18721362 | Medicaid | NM |
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 |
|---|---|---|---|
| 1762 | NM | MD | Pediatric Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Central Consolidated School District #22 | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Local Education Agency (LEA)
- Shiprock, NM
- NPI 1487798567
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165795200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1326108218",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "31277 CR L",
"city": "MANCOS",
"state": "CO",
"postal_code": "81328",
"telephone_number": "505-649-2045"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "US HWY 64 OLD HIGH SCHOOL ROAD",
"city": "SHIPROCK",
"state": "NM",
"postal_code": "87420",
"telephone_number": "505-368-5163",
"fax_number": "505-368-5502"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REIS",
"first_name": "DAVID",
"middle_name": "J",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225XP0200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Pediatrics",
"state": "NM",
"license": "1762",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "18721362",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Shiprock, NM
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.