Active NPI
M. Renee Willms, OTR
- Occupational Therapist
- Austin, TX
National Provider Identifier
1790825230
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 104079
- Practice address
- 1825 Fortview Rd
Suite 103
Austin, TX 78704-7657 - Phone
- (512) 444-4263
- Fax
- (512) 444-4254
- NPI assigned
- Feb 7, 2007
- Last updated
- Mar 30, 2012
- 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 |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 104079 | TX | Primary |
Addresses
Primary practice location
1825 Fortview Rd
Suite 103
Austin, TX 78704-7657
Mailing address
1825 Fortview Rd
Suite 103
Austin, TX 78704-7657
Phone (512) 444-4263
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 847T18 | Other | TX | BCBSTX PROVIDER NUMBER |
| 104079 | Other | TX | STATE |
| 0A5012 | Other | TX | MEDICARE GROUP PTAN |
| TXB108109 | Other | TX | MEDICARE PTAN |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 104079 | TX | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170806400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1333065600000",
"number": "1790825230",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1825 FORTVIEW RD",
"address_2": "SUITE 103",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787047657",
"telephone_number": "512-444-4263",
"fax_number": "512-444-4264"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1825 FORTVIEW RD",
"address_2": "SUITE 103",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787047657",
"telephone_number": "512-444-4263",
"fax_number": "512-444-4254"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLMS",
"first_name": "M.",
"middle_name": "RENEE",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-07",
"last_updated": "2012-03-30",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "TX",
"license": "104079",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBSTX PROVIDER NUMBER",
"identifier": "847T18",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE",
"identifier": "104079",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE GROUP PTAN",
"identifier": "0A5012",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "TXB108109",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Austin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.