Active NPI
Brendin Gillies
- Occupational Therapy Assistant
- Clackamas, OR
National Provider Identifier
1699324475
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- OTA-258
- Practice address
- 12901 SE 97TH Ave Ste 180
Clackamas, OR 97015-7903 - Phone
- (971) 206-6337
- NPI assigned
- Sep 5, 2019
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | OTA-258 | HI | Primary |
Addresses
Primary practice location
12901 SE 97TH Ave Ste 180
Clackamas, OR 97015-7903
Mailing address
2601 Network Blvd Ste 102
Frisco, TX 75034-9092
Phone (972) 372-6750
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 |
|---|---|---|---|
| OTA-258 | HI | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1567641600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1691020800000",
"number": "1699324475",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2601 NETWORK BLVD STE 102",
"city": "FRISCO",
"state": "TX",
"postal_code": "750349092",
"telephone_number": "972-372-6750"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12901 SE 97TH AVE STE 180",
"city": "CLACKAMAS",
"state": "OR",
"postal_code": "970157903",
"telephone_number": "971-206-6337"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GILLIES",
"first_name": "BRENDIN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-09-05",
"last_updated": "2023-08-03",
"certification_date": "2023-08-03",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "HI",
"license": "OTA-258",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clackamas, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 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.