Sara C Braddy, MOTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

OT2316 Issued in MS

Practice address

311 N Main St
Picayune, MS 39466-3313

Phone

(601) 799-4065

Fax

(601) 620-4117

NPI assigned

Sep 12, 2013

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

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.

• Fundamental Therapy LLC

  • Specialist
  • Picayune, MS
  • NPI 1659796860
  NPD (past) Authorized official

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

{
    "created_epoch": "1378944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1420848000000",
    "number": "1710312442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 NEWT MITCHELL RD",
            "city": "PICAYUNE",
            "state": "MS",
            "postal_code": "394669224",
            "telephone_number": "601-916-8329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 N MAIN ST",
            "city": "PICAYUNE",
            "state": "MS",
            "postal_code": "394663313",
            "telephone_number": "601-799-4065",
            "fax_number": "601-620-4117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADDY",
        "first_name": "SARA",
        "middle_name": "C",
        "name_prefix": "Mrs.",
        "credential": "MOTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-09-12",
        "last_updated": "2015-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MS",
            "license": "OT2316",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09938061",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James J Blount III, MD
• Julie D Bogdan, PA
• Dewitt L Bolton, MD
• Deslie Bonano, LCSW, BCD
• Kenneth Gerard Boutte Jr., PHARMD
• Jefferson Buntin, N.P.
• Jana B Burge
• Tiffany Burnette, APRN
• Glenn A Butt, M.D.
• Jessica Byrd

• All providers in Picayune, MS
• Occupational Therapist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2015; 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.