Individual provider Active NPI

Brian Koetter

  • Occupational Therapist
  • Georgetown, TX
National Provider Identifier
1871184788
Registry record updated Feb 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
Practice address
4402 Williams Dr Ste 115
Georgetown, TX 78628-1388
Phone
(512) 256-7627
NPI assigned
Feb 2, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X Primary

Addresses

Primary practice location

4402 Williams Dr Ste 115
Georgetown, TX 78628-1388

Mailing address

4402 Williams Dr Ste 115
Georgetown, TX 78628-1388
Phone (512) 256-7627

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

LicenseStateTypeSpecialty
121374TXMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Jacqueline Kozak CurrentSince Nov 6, 2022 Accepting new patients
Allied Therapies of Texas, PLLC PastSince Mar 1, 2021 Accepting new patients

Locations

4402 Williams Dr
Ste 115
Georgetown, TX 78628
Phone (512) 256-7627

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1612224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612224000000",
    "number": "1871184788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4402 WILLIAMS DR STE 115",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786281388",
            "telephone_number": "512-256-7627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4402 WILLIAMS DR STE 115",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786281388",
            "telephone_number": "512-256-7627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOETTER",
        "first_name": "BRIAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-02-02",
        "last_updated": "2021-02-02",
        "certification_date": "2021-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Georgetown, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 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.