Active NPI
Courtney L Broome, OT
- Occupational Therapist
- Gulfport, MS
National Provider Identifier
1407014137
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT2180
- Practice address
- 15476B Dedeaux Rd
Gulfport, MS 39503-2637 - Phone
- (228) 539-3232
- Fax
- (228) 539-3230
- NPI assigned
- May 29, 2008
- 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 Therapist | 225X00000X | OT2180 | MS | Primary |
Addresses
Primary practice location
15476B Dedeaux Rd
Gulfport, MS 39503-2637
Mailing address
PO Box 8419
Biloxi, MS 39535-8087
Phone (228) 388-5714
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033218524 | Other | MS | GROUP NPI |
| C02726 | Other | MS | MEDICARE GROUP |
| 090-15385 | Medicaid | MS | |
| 256545 | Other | MS | MEDICARE PART A |
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 |
|---|---|---|---|
| OT2180 | MS | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Encore Rehabilitation, Inc. | 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.
-
- Physical Therapy Clinic/Center
- Biloxi, MS
- NPI 1720221195
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1212019200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1212019200000",
"number": "1407014137",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 8419",
"city": "BILOXI",
"state": "MS",
"postal_code": "395358087",
"telephone_number": "228-388-5714",
"fax_number": "228-388-0017"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15476B DEDEAUX RD",
"city": "GULFPORT",
"state": "MS",
"postal_code": "395032637",
"telephone_number": "228-539-3232",
"fax_number": "228-539-3230"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROOME",
"first_name": "COURTNEY",
"middle_name": "L",
"credential": "OT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-05-29",
"last_updated": "2008-05-29",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MS",
"license": "OT2180",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GROUP NPI",
"identifier": "1033218524",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE GROUP",
"identifier": "C02726",
"state": "MS"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "090-15385",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PART A",
"identifier": "256545",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gulfport, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.