Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Keith Tisdell

Individual provider Occupational Therapist · NPI 1477550630

Keith Tisdell is an Occupational Therapist in Private Practice in Kyle, Texas. Qualified in 2001, 25 years ago. Practices with Legacy Healthcare Services Inc, a 3,624-clinician group and accepts Medicare assignment. Licensed in Florida.

Years since qualifying
25
Licensed in
FL
In the registry since
2005
Specialties on file
2

Practice location Address checks out

189 Decker
Kyle, TX 78640-5791
Phone: (954) 328-5436
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Occupational Therapist (primary) Taxonomy 225X00000X · Licence 113654 (FL)
Occupational Therapist Taxonomy 225X00000X · Licence 10016 (FL)

Record details

NPI number1477550630
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedJuly 3, 2005
Last updated in NPPESJanuary 11, 2012
Mailing address189 Decker, Kyle, TX 78640-5791

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyOCCUPATIONAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2001 (25 years in practice)
Group practice Legacy Healthcare Services Inc — 3624 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Kyle