Active NPI
Tameka Tiana Ruddock
- Behavior Technician
- Windsor, CT
National Provider Identifier
1740752443
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 186 Windbrook Dr
Windsor, CT 06095-3563 - Phone
- (860) 992-7504
- NPI assigned
- Dec 19, 2018
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | CT | Primary |
Addresses
Primary practice location
186 Windbrook Dr
Windsor, CT 06095-3563
Mailing address
186 Windbrook Dr
Windsor, CT 06095-3563
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| EHH0970594248 | Medicaid | CT |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1545177600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1545177600000",
"number": "1740752443",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "186 WINDBROOK DR",
"city": "WINDSOR",
"state": "CT",
"postal_code": "060953563"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "186 WINDBROOK DR",
"city": "WINDSOR",
"state": "CT",
"postal_code": "060953563",
"telephone_number": "860-992-7504"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUDDOCK",
"first_name": "TAMEKA",
"middle_name": "TIANA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-12-19",
"last_updated": "2018-12-19",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "CT",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "EHH0970594248",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Windsor, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.