Active NPI
Dylan Leitnaker, OTR/L
- Occupational Therapist
- Johnson City, TN
National Provider Identifier
1104382449
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 6162
- Practice address
- 525 W Oakland Ave Ste 205
Johnson City, TN 37604-1673 - Phone
- (423) 282-1700
- NPI assigned
- Feb 12, 2019
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 6162 | TN | Primary |
Addresses
Primary practice location
525 W Oakland Ave Ste 205
Johnson City, TN 37604-1673
Mailing address
203 Roy Martin Rd
Johnson City, TN 37615-3125
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 |
|---|---|---|---|
| 6162 | TN | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Talkback ABA LLC | Past | Accepting new patients | |
| Talkback, Inc. | Occupational Therapist | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Behavior Analyst
- Johnson City, TN
- NPI 1235973686
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1549929600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1549929600000",
"number": "1104382449",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "203 ROY MARTIN RD",
"city": "JOHNSON CITY",
"state": "TN",
"postal_code": "376153125"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "525 W OAKLAND AVE STE 205",
"city": "JOHNSON CITY",
"state": "TN",
"postal_code": "376041673",
"telephone_number": "423-282-1700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEITNAKER",
"first_name": "DYLAN",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-02-12",
"last_updated": "2019-02-12",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "TN",
"license": "6162",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Johnson City, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.