Active NPI
Prueksa Chittham-Bledsoe, OTR
- Occupational Therapist
- Grand Island, NE
National Provider Identifier
1669879607
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 2419
- Practice address
- 3119 W Faidley Ave
Grand Island, NE 68803-4114 - Phone
- (816) 806-3324
- NPI assigned
- Nov 19, 2014
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 2014028928 | MO | |
| Occupational Therapist | 225X00000X | 2419 | NE | Primary |
Addresses
Primary practice location
3119 W Faidley Ave
Grand Island, NE 68803-4114
Mailing address
3827 Meadow Way TRL
Grand Island, NE 68803-1557
Phone (816) 806-3324
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 |
|---|---|---|---|
| 2419 | NE | MD | Diagnostic Radiology Physician |
| 2014028928 | MO | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1416355200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1643760000000",
"number": "1669879607",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3827 MEADOW WAY TRL",
"city": "GRAND ISLAND",
"state": "NE",
"postal_code": "688031557",
"telephone_number": "816-806-3324"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3119 W FAIDLEY AVE",
"city": "GRAND ISLAND",
"state": "NE",
"postal_code": "688034114",
"telephone_number": "816-806-3324"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHITTHAM-BLEDSOE",
"first_name": "PRUEKSA",
"name_prefix": "Mrs.",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-11-19",
"last_updated": "2022-02-02",
"certification_date": "2022-02-02",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MO",
"license": "2014028928",
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NE",
"license": "2419",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Island, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.