Active NPI
Matthew Lee Mims, COTA
- Occupational Therapy Assistant
- Spring, TX
National Provider Identifier
1194062083
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 210118
- Practice address
- 603 Leaflet LN
Spring, TX 77388-5961 - Phone
- (214) 422-3631
- NPI assigned
- Jan 11, 2013
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 210118 | TX | Primary |
| Occupational Therapy Assistant | 224Z00000X | 2974 | NM |
Addresses
Primary practice location
603 Leaflet LN
Spring, TX 77388-5961
Mailing address
603 Leaflet LN
Spring, TX 77388-5961
Phone (214) 422-3631
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 |
|---|---|---|---|
| 2974 | NM | MD | Professional Counselor |
| 210118 | TX | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1357862400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1692748800000",
"number": "1194062083",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "603 LEAFLET LN",
"city": "SPRING",
"state": "TX",
"postal_code": "773885961",
"telephone_number": "214-422-3631"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "603 LEAFLET LN",
"city": "SPRING",
"state": "TX",
"postal_code": "773885961",
"telephone_number": "214-422-3631"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIMS",
"first_name": "MATTHEW",
"middle_name": "LEE",
"credential": "COTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-01-11",
"last_updated": "2023-08-23",
"certification_date": "2023-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "TX",
"license": "210118",
"primary": true
},
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "NM",
"license": "2974",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Spring, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.