Individual provider Active NPI

Nicole Blick, OTR

  • Pediatric Occupational Therapist
  • Killeen, TX
National Provider Identifier
1821778754
Registry record updated Jul 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Occupational TherapistTaxonomy code 225XP0200X
Practice address
1102 Winkler Ave
Killeen, TX 76542-6249
Phone
(254) 630-4844
Fax
(254) 781-4312
NPI assigned
Jul 25, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 25, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Occupational Therapist 225XP0200X Primary

Addresses

Primary practice location

1102 Winkler Ave
Killeen, TX 76542-6249

Mailing address

1102 Winkler Ave
Killeen, TX 76542-6249
Phone (254) 634-8505

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241025001607 TX Practitioner - Occupational Therapist in Private Practice 3476086737 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Barr Physical Therapy, P.C. Pediatrics CurrentSince Sep 10, 2024 Accepting new patients
Barr Physical Therapy, P.C. Pediatrics Past Accepting new patients
San Luis Walk-in Clinic, Inc. PastSince Jul 31, 2023 Accepting new patients

Locations

1102 Winkler Ave
Killeen, TX 76542
Phone (254) 634-8505

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/11823/brand/2/csg/41/fhir/r4

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1690243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690243200000",
    "number": "1821778754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1102 WINKLER AVE",
            "city": "KILLEEN",
            "state": "TX",
            "postal_code": "765426249",
            "telephone_number": "254-634-8505",
            "fax_number": "254-781-4312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1102 WINKLER AVE",
            "city": "KILLEEN",
            "state": "TX",
            "postal_code": "765426249",
            "telephone_number": "254-630-4844",
            "fax_number": "254-781-4312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLICK",
        "first_name": "NICOLE",
        "credential": "OTR",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-07-25",
        "last_updated": "2023-07-25",
        "certification_date": "2023-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Killeen, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.