NPIMap

Organization Active NPI

Triple E OT, Inc

  • Occupational Therapist
  • Defuniak Springs, FL
National Provider Identifier
1720395759
Registry record updated Sep 13, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
OT5156 Issued in FL
Legal business name
TRIPLE E OT, INC
Practice address
450 Lakeview Dr
Defuniak Springs, FL 32433-4058
Phone
(850) 401-1227
Fax
(850) 892-6994
NPI assigned
Sep 13, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2010

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

Authorized official

Name
Kim E Hydle, OTR/LNPI 1033370143
Title
Occupational Therapist/Director
Phone
(850) 682-8388

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225X00000X OT5156 FL Primary

Addresses

Primary practice location

450 Lakeview Dr
Defuniak Springs, FL 32433-4058

Mailing address

4100 S Ferdon Blvd
Suite C-1
Crestview, FL 32536-5252
Phone (850) 682-8388

Other identifiers 1

IdentifierTypeStateIssuer
000124300MedicaidFL

National Provider Directory

National Provider Directory
Tax ID family
Triple E OT Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4100 S Ferdon Blvd
Ste C1
Crestview, FL 32536
Phone (850) 269-7550

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1284336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1284336000000",
    "number": "1720395759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4100 S FERDON BLVD",
            "address_2": "SUITE C-1",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325365252",
            "telephone_number": "850-682-8388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 LAKEVIEW DR",
            "city": "DEFUNIAK SPRINGS",
            "state": "FL",
            "postal_code": "324334058",
            "telephone_number": "850-401-1227",
            "fax_number": "850-892-6994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRIPLE E OT, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-13",
        "last_updated": "2010-09-13",
        "status": "A",
        "authorized_official_last_name": "HYDLE",
        "authorized_official_first_name": "KIM",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OCCUPATIONAL THERAPIST/DIRECTOR",
        "authorized_official_telephone_number": "850-682-8388",
        "authorized_official_credential": "OTR/L"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Occupational Therapist",
            "state": "FL",
            "license": "OT5156",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000124300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Defuniak Springs, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2010; 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.