Active NPI
Clyde Deveon Edwards, OTR/L
- Occupational Therapist
- Houston, TX
National Provider Identifier
1558026229
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 121331
- Practice address
- 7600 Beechnut St
Houston, TX 77074-4302 - Phone
- (713) 456-5000
- NPI assigned
- Nov 7, 2021
- Sex
- Male
- 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 Therapist | 225X00000X | 121331 | TX | Primary |
Addresses
Primary practice location
7600 Beechnut St
Houston, TX 77074-4302
Mailing address
6057 San Juan Dr
Baton Rouge, LA 70811-4130
Phone (225) 636-8174
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 121331 | Other | TX | OCCUPATIONAL THERAPY LICENSE |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | clyde.edwards@memorialhermann.org | Direct | Memorial Hermann Health System |
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 |
|---|---|---|---|
| 121331 | TX | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1636243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1636243200000",
"number": "1558026229",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6057 SAN JUAN DR",
"city": "BATON ROUGE",
"state": "LA",
"postal_code": "708114130",
"telephone_number": "225-636-8174"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7600 BEECHNUT ST",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770744302",
"telephone_number": "713-456-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDWARDS",
"first_name": "CLYDE",
"middle_name": "DEVEON",
"credential": "OTR/L",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-11-07",
"last_updated": "2021-11-07",
"certification_date": "2021-11-07",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "TX",
"license": "121331",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OCCUPATIONAL THERAPY LICENSE",
"identifier": "121331",
"state": "TX"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "clyde.edwards@memorialhermann.org",
"affiliation": "Y",
"endpointDescription": "Professional Work Email",
"affiliationName": "Memorial Hermann Health System",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "7600 Beechnut St",
"city": "Houston",
"state": "TX",
"country_code": "US",
"postal_code": "770744302",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.