Unknown Individual – Occupational Therapist, NPI 1417074055

Unknown Individual is a healthcare provider. based in Longview, Texas. specializing in Occupational Therapist. They hold a License No. 106296 (TX). The NPI Number for Unknown Individual is 1417074055

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1417074055
Phone
(903) 291-1570
Address
3011 EVANGELINE ST
Deactivation Date
26 July 2023
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

Provider Addresses for Unknown Individual

  • 3011 EVANGELINE ST

    LONGVIEW, TX 756051501

    Phone: (903) 291-1570

    Type: Mailing

  • 103 W LOOP 281

    SUITE 800

    LONGVIEW, TX 756054653

    Phone: (903) 315-5580

    Fax: (903) 315-2804

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

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Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

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Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 75605)

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Reviews

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Frequently asked questions

How is Unknown Individual identified in CMS data?
CMS-hosted NPPES data lists Unknown Individual with NPI 1417074055.
What dates should I check for Unknown Individual's activity?
We display what the registry publishes: Unknown Individual appears inactive there.
What is Unknown Individual best known for clinically?
Directory data describes Unknown Individual with Occupational Therapist. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual based?
Unknown Individual is tied to Longview, Texas in the data we show; additional addresses may exist on the full record.
Why does Unknown Individual have multiple addresses?
2 practice locations appear in the available data. Multiple addresses are common for hospital privileges, telehealth, or multi-site groups.

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