Tori Breanne Blackwell, MOT, OTR/L

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

OT007091 Issued in GA

Practice address

3731-A 6TH Avenue
San Diego, CA 92103

Phone

(619) 291-3515

Fax

(619) 374-2552

NPI assigned

Jul 26, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Tori Breanne Ragan Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pediatric Therapies of SE Ga, LLC

  • Pediatric Occupational Therapist
  • Kingsland, GA
  • NPI 1710346267

  Pediatrics

  NPD (past)
• Pediatric Therapies of SE Ga, LLC

  • Pediatric Occupational Therapist
  • Brunswick, GA
  • NPI 1841577111

  Pediatrics

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1532563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582156800000",
    "number": "1689151284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3731-A 6TH AVENUE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92103",
            "telephone_number": "619-291-3515",
            "fax_number": "619-374-2552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3731-A 6TH AVENUE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92103",
            "telephone_number": "619-291-3515",
            "fax_number": "619-374-2552"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4212 Coral Park Dr",
            "address_purpose": "LOCATION",
            "city": "Brunswick",
            "state": "GA",
            "postal_code": "315203016",
            "country_code": "US",
            "telephone_number": "912-996-2069",
            "fax_number": "912-265-0041",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACKWELL",
        "first_name": "TORI",
        "middle_name": "BREANNE",
        "name_prefix": "Mrs.",
        "credential": "MOT, OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-26",
        "last_updated": "2020-02-20",
        "certification_date": "2020-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "GA",
            "license": "OT007091",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE BOARD OF OCCUPATIONAL THERAPY",
            "identifier": "OT007091",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TORI",
            "last_name": "RAGAN",
            "middle_name": "BREANNE",
            "credential": "MOT, OTR/L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Raquel Blackshere, RN
• Blacksphere Chiropractic, PC
• Christopher Martin Blackwell, MD
• Johnny Blackwell Jr., A.A.
• Sandra Lynn Blackwell, RRT
• Samuel Austin Blackwood, CADC, CAS
• Sandra Blackwood, CD
• Allison Blacutt, DACM. L.AC
• Miguel Angel Blacutt, MD
• Kent Alan Blade, M.D.

• Pediatric Occupational Therapist in San Diego, CA
• Providers in San Diego, CA by specialty
• Pediatric Occupational Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 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.

Verify at the official NPI Registry.