Active NPI
Mary Nickell
- Occupational Therapist
- Edinburg, TX
National Provider Identifier
1831625300
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 118056
- Practice address
- 3436 Los Lagos Dr
Edinburg, TX 78542-5589 - Phone
- (586) 258-9101
- NPI assigned
- May 3, 2017
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 118056 | TX | Primary |
| Occupational Therapist | 225X00000X | 5201007340 | MI |
Addresses
Primary practice location
3436 Los Lagos Dr
Edinburg, TX 78542-5589
Mailing address
3436 Los Lagos Dr
Edinburg, TX 78542-5589
Other names 1
- Mary Denardi
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5201007340 | MI | MD | Occupational Therapist |
| 118056 | TX | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1493769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1493769600000",
"number": "1831625300",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3436 LOS LAGOS DR",
"city": "EDINBURG",
"state": "TX",
"postal_code": "785425589"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3436 LOS LAGOS DR",
"city": "EDINBURG",
"state": "TX",
"postal_code": "785425589",
"telephone_number": "586-258-9101"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICKELL",
"first_name": "MARY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-05-03",
"last_updated": "2017-05-03",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "TX",
"license": "118056",
"primary": true
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MI",
"license": "5201007340",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "MARY",
"last_name": "DENARDI",
"credential": "OTR",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Edinburg, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.