Active NPI
Marybeth Oliva, OTR/L
- Occupational Therapist
- Coppell, TX
National Provider Identifier
1710510219
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- Practice address
- 370 S State Highway 121 N Ste 105
Coppell, TX 75019-4265 - Phone
- (817) 479-7019
- NPI assigned
- Feb 13, 2020
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pediatric Occupational Therapist | 225XP0200X | 115006 | TX | |
| Occupational Therapist | 225X00000X | Primary |
Addresses
Primary practice location
370 S State Highway 121 N Ste 105
Coppell, TX 75019-4265
Mailing address
1536 Fairfield CT
Lewisville, TX 75077-3722
Phone (903) 258-2888
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 |
|---|---|---|---|
| 115006 | TX | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1581552000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1646870400000",
"number": "1710510219",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1536 FAIRFIELD CT",
"city": "LEWISVILLE",
"state": "TX",
"postal_code": "750773722",
"telephone_number": "903-258-2888"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "370 S STATE HIGHWAY 121 N STE 105",
"city": "COPPELL",
"state": "TX",
"postal_code": "750194265",
"telephone_number": "817-479-7019"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLIVA",
"first_name": "MARYBETH",
"credential": "OTR/L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-02-13",
"last_updated": "2022-03-10",
"certification_date": "2022-03-10",
"status": "A"
},
"taxonomies": [
{
"code": "225XP0200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Pediatrics",
"state": "TX",
"license": "115006",
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coppell, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.