NPIMap

Individual provider Active NPI

Brienne Nicole Rogers, OTR/L, CLT

  • Occupational Therapist
  • Fruita, CO
National Provider Identifier
1508062985
Registry record updated Oct 8, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
OT.0003260 Issued in CO
Practice address
300 W Ottley Ave
Fruita, CO 81521-2118
Phone
(970) 858-2575
Fax
(970) 858-4569
NPI assigned
Jun 22, 2007
Last updated
Oct 8, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X OT.0003260 CO Primary

Addresses

Primary practice location

300 W Ottley Ave
Fruita, CO 81521-2118

Mailing address

PO Box 130
Fruita, CO 81521-0130
Phone (970) 858-2186

Other practice location 1

551 Kokopelli Blvd Unit E
Fruita, CO 81521-6305
Phone (970) 858-2556

Other identifiers 1

IdentifierTypeStateIssuer
4111589MedicaidWA

Other names 1

  • Brienne Nicole Sullivan Former name

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
OT.0003260COMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Affiliated Podiatrists of Illinois LTD. Past Accepting new patients
Brethren Home of Girard Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570492800000",
    "number": "1508062985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 130",
            "city": "FRUITA",
            "state": "CO",
            "postal_code": "815210130",
            "telephone_number": "970-858-2186",
            "fax_number": "970-858-2208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 W OTTLEY AVE",
            "city": "FRUITA",
            "state": "CO",
            "postal_code": "815212118",
            "telephone_number": "970-858-2575",
            "fax_number": "970-858-4569"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "551 Kokopelli Blvd Unit E",
            "address_purpose": "LOCATION",
            "city": "Fruita",
            "state": "CO",
            "postal_code": "815216305",
            "country_code": "US",
            "telephone_number": "970-858-2556",
            "fax_number": "970-858-8244",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROGERS",
        "first_name": "BRIENNE",
        "middle_name": "NICOLE",
        "credential": "OTR/L, CLT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-22",
        "last_updated": "2019-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "CO",
            "license": "OT.0003260",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4111589",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BRIENNE",
            "last_name": "SULLIVAN",
            "middle_name": "NICOLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Fruita, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 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.

Verify at the official NPI Registry.