Active NPI
Kelley E Brodbeck, OT
- Occupational Therapist
- San Antonio, TX
National Provider Identifier
1639460611
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 106525
- Practice address
- 18323 Sonterra PL
San Antonio, TX 78258-4353 - Phone
- (210) 495-4606
- NPI assigned
- Apr 26, 2011
- Sex
- Female
- Sole proprietor
- No
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 | 106525 | TX | Primary |
Addresses
Primary practice location
18323 Sonterra PL
San Antonio, TX 78258-4353
Mailing address
2222 Sullivan TRL
Easton, PA 18040-7958
Phone (610) 991-2034
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 |
|---|---|---|---|
| 106525 | TX | MD | School Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1303776000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1303776000000",
"number": "1639460611",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2222 SULLIVAN TRL",
"city": "EASTON",
"state": "PA",
"postal_code": "180407958",
"telephone_number": "610-991-2034",
"fax_number": "610-438-2046"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18323 SONTERRA PL",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782584353",
"telephone_number": "210-495-4606"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRODBECK",
"first_name": "KELLEY",
"middle_name": "E",
"credential": "OT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-04-26",
"last_updated": "2011-04-26",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "TX",
"license": "106525",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.