Active NPI
Derek Wiston
- Occupational Therapist
- Boca Raton, FL
National Provider Identifier
1972015600
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 18829
- Practice address
- 21065 Powerline Rd Ste 2a
Boca Raton, FL 33433-2311 - Phone
- (561) 883-7800
- Fax
- (561) 883-7800
- NPI assigned
- Nov 3, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 18829 | FL | Primary |
Addresses
Primary practice location
21065 Powerline Rd Ste 2a
Boca Raton, FL 33433-2311
Mailing address
11671 Island Lakes LN
Boca Raton, FL 33498-6802
Phone (561) 504-1725
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
| License | State | Type | Specialty |
|---|---|---|---|
| 18829 | FL | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Neuroscience Consultants LLP | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Specialist
- Medley, FL
- NPI 1346217452
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1509667200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1509667200000",
"number": "1972015600",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11671 ISLAND LAKES LN",
"city": "BOCA RATON",
"state": "FL",
"postal_code": "334986802",
"telephone_number": "561-504-1725"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21065 POWERLINE RD STE 2A",
"city": "BOCA RATON",
"state": "FL",
"postal_code": "334332311",
"telephone_number": "561-883-7800",
"fax_number": "561-883-7800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WISTON",
"first_name": "DEREK",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-11-03",
"last_updated": "2017-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "FL",
"license": "18829",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boca Raton, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 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.