Active NPI
Kellie McBroom, OTR
- Occupational Therapist
- Commerce, TX
National Provider Identifier
1801804562
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 110810
- Practice address
- 2544 Mangum St
Commerce, TX 75428-3515 - Phone
- (903) 886-7669
- Fax
- (903) 886-7679
- NPI assigned
- Aug 4, 2006
- Last updated
- Jul 8, 2007
- 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 | 110810 | TX | Primary |
Addresses
Primary practice location
2544 Mangum St
Commerce, TX 75428-3515
Mailing address
PO Box 64
Celeste, TX 75423-0064
Phone (903) 568-8558
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8T3108 | Other | TX | BCBS PROVIDER |
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 |
|---|---|---|---|
| 110810 | TX | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Endeavor Rehab Center Inc | Past | Accepting new patients | |
| Hulsey Therapy Services, PC | Occupational Therapist | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Comprehensive Outpatient Rehabilitation Facility (CORF)
- Commerce, TX
- NPI 1659379667
Occupational Therapist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154649600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1801804562",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 64",
"city": "CELESTE",
"state": "TX",
"postal_code": "754230064",
"telephone_number": "903-568-8558"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2544 MANGUM ST",
"city": "COMMERCE",
"state": "TX",
"postal_code": "754283515",
"telephone_number": "903-886-7669",
"fax_number": "903-886-7679"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCBROOM",
"first_name": "KELLIE",
"name_prefix": "Mrs.",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "TX",
"license": "110810",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS PROVIDER",
"identifier": "8T3108",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Commerce, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.