Individual provider Active NPI

Tiffany N Brush, OT

  • Occupational Therapist
  • Fort Worth, TX
National Provider Identifier
1982901310
Registry record updated Feb 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
1366471450 Issued in TX
Practice address
5316 Trail Lake Dr
Fort Worth, TX 76133-1931
Phone
(817) 292-8787
Fax
(817) 789-6849
NPI assigned
Feb 21, 2011
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
1366471450TXMDOccupational Therapy Assistant

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 1366471450 TX Primary

Addresses

NPPES NPI Registry

Primary practice location

5316 Trail Lake Dr
Fort Worth, TX 76133-1931

Mailing address

5316 Trail Lake Dr
Fort Worth, TX 76133-1931
Phone (817) 292-8787

Other identifiers 2

NPPES NPI Registry
IdentifierTypeStateIssuer
207164901MedicaidTX
149984001MedicaidTX

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 21, 2011.

{
    "created_epoch": "1298246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1298246400000",
    "number": "1982901310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5316 TRAIL LAKE DR",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761331931",
            "telephone_number": "817-292-8787",
            "fax_number": "817-789-6849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5316 TRAIL LAKE DR",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761331931",
            "telephone_number": "817-292-8787",
            "fax_number": "817-789-6849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUSH",
        "first_name": "TIFFANY",
        "middle_name": "N",
        "credential": "OT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-02-21",
        "last_updated": "2011-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "TX",
            "license": "1366471450",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "207164901",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "149984001",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2011; 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.