Macy McKenna Lesiak, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

2843 Issued in NE

Practice address

3004 W Faidley Ave
Grand Island, NE 68803-4109

Phone

(308) 398-5170

Fax

(308) 398-5175

NPI assigned

Sep 20, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Macy McKenna Gustafson Former name

Medicare fee-for-service enrollment

Enrolled in NE

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Go Physical Therapy, LLC

  • Physical Therapist
  • Grand Island, NE
  • NPI 1184627911
  Medicare reassignment NPD

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

{
    "created_epoch": "1695168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702857600000",
    "number": "1316725344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5285",
            "city": "GRAND ISLAND",
            "state": "NE",
            "postal_code": "688025285",
            "telephone_number": "308-675-1853",
            "fax_number": "308-210-4121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3004 W FAIDLEY AVE",
            "city": "GRAND ISLAND",
            "state": "NE",
            "postal_code": "688034109",
            "telephone_number": "308-398-5170",
            "fax_number": "308-398-5175"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LESIAK",
        "first_name": "MACY",
        "middle_name": "MCKENNA",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-20",
        "last_updated": "2023-12-18",
        "certification_date": "2023-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NE",
            "license": "2843",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MACY",
            "last_name": "GUSTAFSON",
            "middle_name": "MCKENNA",
            "credential": "OTR/L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Yailin Leon Garrido
• Ignacio Leon
• Chancey Leonard
• Julianna Angelina Leonard
• Laurence Frank Lesiak, M.D.
• Tara Lesiak
• Katrina Anne Letheby, M.S.
• Greyson Hudson Levy
• Bridget Lewandowski
• James E Lewandowski, DPM

• Occupational Therapist in Grand Island, NE
• Providers in Grand Island, NE by specialty
• Occupational Therapist in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2023; 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.