Active NPI
Bryan Palacios, OTR
- Occupational Therapist
- Cape Coral, FL
National Provider Identifier
1619502804
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 20681
- Practice address
- 2629 Del Prado Blvd S
Cape Coral, FL 33904-5769 - Phone
- (239) 246-6972
- NPI assigned
- Mar 8, 2020
- 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 | 20681 | FL | Primary |
Addresses
Primary practice location
2629 Del Prado Blvd S
Cape Coral, FL 33904-5769
Mailing address
160 SE 17TH St
Cape Coral, FL 33990-2213
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 |
|---|---|---|---|
| 20681 | FL | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1583625600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1583712000000",
"number": "1619502804",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "160 SE 17TH ST",
"city": "CAPE CORAL",
"state": "FL",
"postal_code": "339902213"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2629 DEL PRADO BLVD S",
"city": "CAPE CORAL",
"state": "FL",
"postal_code": "339045769",
"telephone_number": "239-246-6972"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PALACIOS",
"first_name": "BRYAN",
"credential": "OTR",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-03-08",
"last_updated": "2020-03-09",
"certification_date": "2020-03-09",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "FL",
"license": "20681",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cape Coral, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.