Toni Edwards Bouck, O.T.R,

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

12040 Issued in FL

Practice address

3964 Florida Ave
Jay, FL 32565-1104

Phone

(850) 741-6715

NPI assigned

Aug 19, 2009

Last updated

Jan 25, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1250640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611532800000",
    "number": "1770715138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3331 SUMMIT BLVD APT 172",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325034331",
            "telephone_number": "850-741-6715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3964 FLORIDA AVE",
            "city": "JAY",
            "state": "FL",
            "postal_code": "325651104",
            "telephone_number": "850-741-6715"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "101 McAbee Ct",
            "address_purpose": "LOCATION",
            "city": "Gulf Breeze",
            "state": "FL",
            "postal_code": "325614756",
            "country_code": "US",
            "telephone_number": "850-741-6715",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "156 Sandy Creek Landing Rd",
            "address_purpose": "LOCATION",
            "city": "Ponce DE Leon",
            "state": "FL",
            "postal_code": "324553341",
            "country_code": "US",
            "telephone_number": "850-974-8395",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOUCK",
        "first_name": "TONI",
        "middle_name": "EDWARDS",
        "name_prefix": "Mrs.",
        "credential": "O.T.R,",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-08-19",
        "last_updated": "2021-01-25",
        "certification_date": "2021-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "273Y00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Unit",
            "state": "FL",
            "license": "27-0596759",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "FL",
            "license": "12040",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Occupational Therapist in Jay, FL
• Providers in Jay, FL by specialty
• Occupational Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2021; 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.