Active NPI
Brian Eddy, OTR
- Occupational Therapist
- Mansfield, TX
National Provider Identifier
1699183319
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 121211
- Practice address
- 267 N State Highway 360
Mansfield, TX 76063-9073 - Phone
- (817) 778-9361
- NPI assigned
- Jul 25, 2014
- Last updated
- Sep 4, 2023
- Sex
- Male
- 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 | 99062900A | IN | |
| Occupational Therapist | 225X00000X | 121211 | TX | Primary |
Addresses
Primary practice location
267 N State Highway 360
Mansfield, TX 76063-9073
Mailing address
4672 Ardenwood Dr
Fort Worth, TX 76123-4054
Phone (317) 985-4827
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 99062900A | IN | MD | Occupational Therapist |
| 121211 | TX | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rodrigo D. Rodriguez | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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- Aurora, CO
- NPI 1740648187
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1406246400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1693785600000",
"number": "1699183319",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4672 ARDENWOOD DR",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761234054",
"telephone_number": "317-985-4827"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "267 N STATE HIGHWAY 360",
"city": "MANSFIELD",
"state": "TX",
"postal_code": "760639073",
"telephone_number": "817-778-9361"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDDY",
"first_name": "BRIAN",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-07-25",
"last_updated": "2023-09-04",
"certification_date": "2023-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "IN",
"license": "99062900A",
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "TX",
"license": "121211",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mansfield, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.