Kim Renee Baccus, O.T.R

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

109307 Issued in TX

Practice address

3634 Glenn Lakes LN
Suite 200
Missouri City, TX 77459-4062

Phone

(281) 208-6600

Fax

(281) 261-2584

NPI assigned

Jul 29, 2008

Last updated

Jul 29, 2008By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1217289600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1217289600000",
    "number": "1518123637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4910 AIRPORT AVE",
            "address_2": "BUILDING D",
            "city": "ROSENBERG",
            "state": "TX",
            "postal_code": "774715759",
            "telephone_number": "281-239-1369",
            "fax_number": "281-239-0828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3634 GLENN LAKES LN",
            "address_2": "SUITE 200",
            "city": "MISSOURI CITY",
            "state": "TX",
            "postal_code": "774594062",
            "telephone_number": "281-208-6600",
            "fax_number": "281-261-2584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BACCUS",
        "first_name": "KIM",
        "middle_name": "RENEE",
        "name_prefix": "Ms.",
        "credential": "O.T.R",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-29",
        "last_updated": "2008-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "TX",
            "license": "109307",
            "primary": true
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "TX",
            "license": "109307",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Occupational Therapist in Missouri City, TX
• Providers in Missouri City, TX by specialty
• Occupational Therapist in Texas

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

Verify at the official NPI Registry.