Active NPI
Tianna Russell
- Occupational Therapist
- Clovis, CA
National Provider Identifier
1891152401
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 11089
- Practice address
- 9077 N Fowler Ave
Clovis, CA 93619-8626 - Phone
- (559) 304-7573
- NPI assigned
- Jan 27, 2016
- Sex
- Female
- Sole proprietor
- Yes
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 | 11089 | CA | Primary |
| Occupational Therapist | 225X00000X | 264957 | OR |
Addresses
Primary practice location
9077 N Fowler Ave
Clovis, CA 93619-8626
Mailing address
9077 N Fowler Ave
Clovis, CA 93619-8626
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 |
|---|---|---|---|
| 264957 | OR | MD | Occupational Therapist |
| 11089 | CA | MD | Skilled Nursing Facility |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1453852800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1453852800000",
"number": "1891152401",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9077 N FOWLER AVE",
"city": "CLOVIS",
"state": "CA",
"postal_code": "936198626"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9077 N FOWLER AVE",
"city": "CLOVIS",
"state": "CA",
"postal_code": "936198626",
"telephone_number": "559-304-7573"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "TIANNA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-01-27",
"last_updated": "2016-01-27",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "CA",
"license": "11089",
"primary": true
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "OR",
"license": "264957",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clovis, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.