Individual provider Active NPI

Kristin Mahathey, SLP

  • Speech-Language Pathologist
  • Edmond, OK
National Provider Identifier
1073144663
Registry record updated Feb 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
2661 Issued in OK
Practice address
801 Red Oak Ter
Edmond, OK 73003-5021
Phone
(405) 503-1888
NPI assigned
Feb 1, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 1, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 2661 OK Primary

Addresses

Primary practice location

801 Red Oak Ter
Edmond, OK 73003-5021

Mailing address

801 Red Oak Ter
Edmond, OK 73003-5021
Phone (405) 503-1888

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240106000928 OK Practitioner - Qualified Speech Language Pathologist 7214388909 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2661OKMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Healthcare Services Inc Speech-Language Pathologist CurrentSince Dec 18, 2023 Accepting new patients
Legacy Healthcare Services Inc Speech-Language Pathologist CurrentSince Dec 18, 2023 Accepting new patients
Can DO Kids Therapy Past Accepting new patients

Locations

110 Horizon Dr
Ste 310
Raleigh, NC 27615
Phone (970) 215-3300

Organizations & group practices 3

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1580515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580515200000",
    "number": "1073144663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 RED OAK TER",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730035021",
            "telephone_number": "405-503-1888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 RED OAK TER",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730035021",
            "telephone_number": "405-503-1888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAHATHEY",
        "first_name": "KRISTIN",
        "credential": "SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-02-01",
        "last_updated": "2020-02-01",
        "certification_date": "2020-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "OK",
            "license": "2661",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edmond, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.