Individual provider Active NPI

Kendall Jordan Baethge

  • Occupational Therapist
  • Pearland, TX
National Provider Identifier
1912666280
Registry record updated Dec 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
Practice address
2011 Broadway St Ste 130
Pearland, TX 77581-5945
Phone
(281) 997-8509
NPI assigned
Dec 14, 2021
Last updated
Dec 14, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 14, 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

2011 Broadway St Ste 130
Pearland, TX 77581-5945

Mailing address

2011 Broadway St Ste 130
Pearland, TX 77581-5945

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250114002996 TX Practitioner - Occupational Therapist in Private Practice 2668900937 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Bluebonnet Pediatric Therapy LLC CurrentSince Nov 11, 2024 Accepting new patients
Riverkids Houston Therapy, LLC PastSince Sep 23, 2024 Accepting new patients

Locations

18 Scenic Loop Rd
Ste 200D
Boerne, TX 78006
Phone (830) 755-0098

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.

NPI Registry JSON

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

{
    "created_epoch": "1639440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639440000000",
    "number": "1912666280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2011 BROADWAY ST STE 130",
            "city": "PEARLAND",
            "state": "TX",
            "postal_code": "775815945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2011 BROADWAY ST STE 130",
            "city": "PEARLAND",
            "state": "TX",
            "postal_code": "775815945",
            "telephone_number": "281-997-8509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAETHGE",
        "first_name": "KENDALL",
        "middle_name": "JORDAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-12-14",
        "last_updated": "2021-12-14",
        "certification_date": "2021-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pearland, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2021; 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.