Active NPI
Keely Marie Pettus, COTA/L
- Occupational Therapy Assistant
- Hobbs, NM
National Provider Identifier
1386065308
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 2821
- Practice address
- 315 E Clinton St
Hobbs, NM 88240-8238 - Phone
- (575) 393-0755
- Fax
- (575) 393-0249
- NPI assigned
- Dec 17, 2013
- Sex
- Female
- Sole proprietor
- Yes
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 | 2821 | NM | Primary |
Addresses
Primary practice location
315 E Clinton St
Hobbs, NM 88240-8238
Mailing address
315 E Clinton St
Hobbs, NM 88240-8238
Phone (575) 393-0755
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 |
|---|---|---|---|
| 2821 | NM | MD | Occupational Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Regional Education Cooperative VII | 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 and National Provider Directory roles.
-
- Local Education Agency (LEA)
- Hobbs, NM
- NPI 1215944806
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1387238400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1387238400000",
"number": "1386065308",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "315 E CLINTON ST",
"city": "HOBBS",
"state": "NM",
"postal_code": "882408238",
"telephone_number": "575-393-0755",
"fax_number": "575-393-0249"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "315 E CLINTON ST",
"city": "HOBBS",
"state": "NM",
"postal_code": "882408238",
"telephone_number": "575-393-0755",
"fax_number": "575-393-0249"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTUS",
"first_name": "KEELY",
"middle_name": "MARIE",
"name_prefix": "Miss",
"credential": "COTA/L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-12-17",
"last_updated": "2013-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "NM",
"license": "2821",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hobbs, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.