Active NPI
Theresa M. Prudencio, OTR
- Occupational Therapist
- El Paso, TX
National Provider Identifier
1407096530
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 108582
- Practice address
- 1831 Murchison Dr Ste C
El Paso, TX 79902-2917 - Phone
- (915) 351-4441
- NPI assigned
- Mar 2, 2009
- 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 | 108582 | TX | Primary |
Addresses
Primary practice location
1831 Murchison Dr Ste C
El Paso, TX 79902-2917
Mailing address
11529 Clear Lake Way
El Paso, TX 79936-4336
Phone (915) 857-5921
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 |
|---|---|---|---|
| 108582 | TX | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1235952000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1235952000000",
"number": "1407096530",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11529 CLEAR LAKE WAY",
"city": "EL PASO",
"state": "TX",
"postal_code": "799364336",
"telephone_number": "915-857-5921"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1831 MURCHISON DR STE C",
"city": "EL PASO",
"state": "TX",
"postal_code": "799022917",
"telephone_number": "915-351-4441"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRUDENCIO",
"first_name": "THERESA",
"middle_name": "M.",
"name_prefix": "Mrs.",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-03-02",
"last_updated": "2009-03-02",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "TX",
"license": "108582",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in El Paso, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.