Active NPI
Aileen Tan
- Occupational Therapist
- Lubbock, TX
National Provider Identifier
1639419096
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 110410
- Practice address
- 2401 20TH St
Lubbock, TX 79411-1003 - Phone
- (806) 780-4180
- NPI assigned
- Feb 21, 2013
- Sex
- Female
- 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 | 110410 | TX | Primary |
Addresses
Primary practice location
2401 20TH St
Lubbock, TX 79411-1003
Mailing address
2401 20TH St
Lubbock, TX 79411-1003
Phone (806) 780-4180
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 331042299 | Medicaid | TX |
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 |
|---|---|---|---|
| 110410 | TX | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1361404800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1361750400000",
"number": "1639419096",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2401 20TH ST",
"city": "LUBBOCK",
"state": "TX",
"postal_code": "794111003",
"telephone_number": "806-780-4180"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2401 20TH ST",
"city": "LUBBOCK",
"state": "TX",
"postal_code": "794111003",
"telephone_number": "806-780-4180"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAN",
"first_name": "AILEEN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-02-21",
"last_updated": "2013-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "TX",
"license": "110410",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "331042299",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lubbock, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.