Active NPI
Blake Sanca, COTA
- Occupational Therapy Assistant
- Tyler, TX
National Provider Identifier
1689091498
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 212430
- Practice address
- 3200 Troup Hwy
Tyler, TX 75701-8397 - Phone
- (903) 253-0095
- NPI assigned
- Mar 19, 2014
- Last updated
- Mar 19, 2014
- Sex
- Male
- 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 | 212430 | TX | Primary |
Addresses
Primary practice location
3200 Troup Hwy
Tyler, TX 75701-8397
Mailing address
3200 Troup Hwy
Tyler, TX 75701-8397
Phone (903) 253-0095
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 |
|---|---|---|---|
| 212430 | TX | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1395187200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1395187200000",
"number": "1689091498",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3200 TROUP HWY",
"city": "TYLER",
"state": "TX",
"postal_code": "757018397",
"telephone_number": "903-253-0095"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3200 TROUP HWY",
"city": "TYLER",
"state": "TX",
"postal_code": "757018397",
"telephone_number": "903-253-0095"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SANCA",
"first_name": "BLAKE",
"name_prefix": "Mr.",
"credential": "COTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-03-19",
"last_updated": "2014-03-19",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "TX",
"license": "212430",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.