Active NPI
Latisha Shanta Lewis, M.A.T.
- Developmental Therapist
- Belleville, IL
National Provider Identifier
1013297431
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Developmental Therapist
- License
- L200-5377-9925
- Practice address
- 1948 Richmond Springs LN
Belleville, IL 62220-3283 - Phone
- (618) 402-4319
- Fax
- (618) 825-0210
- NPI assigned
- Aug 17, 2011
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Developmental Therapist | 222Q00000X | L200-5377-9925 | IL | Primary |
Addresses
Primary practice location
1948 Richmond Springs LN
Belleville, IL 62220-3283
Mailing address
1948 Richmond Springs LN
Belleville, IL 62220-3283
Phone (618) 402-4319
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L200-5377-9925 | IL | MD | Developmental Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1313539200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1313539200000",
"number": "1013297431",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1948 RICHMOND SPRINGS LN",
"city": "BELLEVILLE",
"state": "IL",
"postal_code": "622203283",
"telephone_number": "618-402-4319"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1948 RICHMOND SPRINGS LN",
"city": "BELLEVILLE",
"state": "IL",
"postal_code": "622203283",
"telephone_number": "618-402-4319",
"fax_number": "618-825-0210"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEWIS",
"first_name": "LATISHA",
"middle_name": "SHANTA",
"name_prefix": "Mrs.",
"credential": "M.A.T.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-08-17",
"last_updated": "2011-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "222Q00000X",
"taxonomy_group": "",
"desc": "Developmental Therapist",
"state": "IL",
"license": "L200-5377-9925",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Belleville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 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.