Active NPI
Austin Carlysle Clyse Underwood, MOT, OTR/L
- Occupational Therapist
- Lincoln, NE
National Provider Identifier
1659679751
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 1557
- Practice address
- 4405 Normal Blvd
Lincoln, NE 68506-5551 - Phone
- (740) 525-9902
- NPI assigned
- Mar 14, 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 | 1557 | NE | Primary |
Addresses
Primary practice location
4405 Normal Blvd
Lincoln, NE 68506-5551
Mailing address
7333 Pioneers Blvd Apt 225
Lincoln, NE 68506-7502
Phone (740) 525-9902
Other names 1
- Austin Carlysle Clyse
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 |
|---|---|---|---|
| 1557 | NE | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1300060800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1300060800000",
"number": "1659679751",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7333 PIONEERS BLVD APT 225",
"city": "LINCOLN",
"state": "NE",
"postal_code": "685067502",
"telephone_number": "740-525-9902"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4405 NORMAL BLVD",
"city": "LINCOLN",
"state": "NE",
"postal_code": "685065551",
"telephone_number": "740-525-9902"
}
],
"practiceLocations": [],
"basic": {
"last_name": "UNDERWOOD",
"first_name": "AUSTIN",
"middle_name": "CARLYSLE CLYSE",
"name_prefix": "Mrs.",
"credential": "MOT, OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-03-14",
"last_updated": "2011-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NE",
"license": "1557",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "AUSTIN",
"last_name": "CLYSE",
"middle_name": "CARLYSLE",
"credential": "MOT, OTR/L",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Lincoln, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 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.