Individual provider Active NPI

Lisa Marie Fore, OTR, CEAS

  • Occupational Therapist
  • Carrollton, TX
National Provider Identifier
1386768133
Registry record updated Jan 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
106656 Issued in TX
Practice address
1000 W Crosby Rd Ste 136
Carrollton, TX 75006-6904
Phone
(817) 658-8808
NPI assigned
Mar 19, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 106656 TX Primary

Addresses

Primary practice location

1000 W Crosby Rd Ste 136
Carrollton, TX 75006-6904

Mailing address

4001 Tara Dr
Colleyville, TX 76034-4106
Phone (178) 658-8808

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

LicenseStateTypeSpecialty
106656TXMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
CKC Holdings LLC PastSince Feb 27, 2022 Accepting new patients
CKC Holdings LLC PastSince Mar 24, 2024 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.

NPI Registry JSON

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

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548288000000",
    "number": "1386768133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4001 TARA DR",
            "city": "COLLEYVILLE",
            "state": "TX",
            "postal_code": "760344106",
            "telephone_number": "178-658-8808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 W CROSBY RD STE 136",
            "city": "CARROLLTON",
            "state": "TX",
            "postal_code": "750066904",
            "telephone_number": "817-658-8808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORE",
        "first_name": "LISA",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "OTR, CEAS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-19",
        "last_updated": "2019-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "TX",
            "license": "106656",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carrollton, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 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.

Verify at the official NPI Registry.