Active NPI
Mallory Jo Spencer, COTA
- Occupational Therapy Assistant
- Henderson, TX
National Provider Identifier
1669094983
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 215209
- Practice address
- 4159 FM 13 W
Henderson, TX 75654-9395 - Phone
- (903) 646-3742
- NPI assigned
- May 8, 2020
- 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 Therapy Assistant | 224Z00000X | 215209 | TX | Primary |
Addresses
Primary practice location
4159 FM 13 W
Henderson, TX 75654-9395
Mailing address
4159 FM 13 W
Henderson, TX 75654-9395
Phone (903) 646-3742
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 |
|---|---|---|---|
| 215209 | TX | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1588896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1588896000000",
"number": "1669094983",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4159 FM 13 W",
"city": "HENDERSON",
"state": "TX",
"postal_code": "756549395",
"telephone_number": "903-646-3742"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4159 FM 13 W",
"city": "HENDERSON",
"state": "TX",
"postal_code": "756549395",
"telephone_number": "903-646-3742"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPENCER",
"first_name": "MALLORY",
"middle_name": "JO",
"credential": "COTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-05-08",
"last_updated": "2020-05-08",
"certification_date": "2020-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "TX",
"license": "215209",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Henderson, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 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.