Active NPI
Theodore Leonard
- Driving and Community Mobility Occupational Therapist
- Jacksonville, FL
National Provider Identifier
1417588336
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Driving and Community Mobility Occupational Therapist
- Practice address
- 1448 Gailwood Cir N
Jacksonville, FL 32218-5286 - Phone
- (090) 469-7646
- NPI assigned
- Jan 29, 2020
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Driving and Community Mobility Occupational Therapist | 225XR0403X | FL | Primary |
Addresses
Primary practice location
1448 Gailwood Cir N
Jacksonville, FL 32218-5286
Mailing address
1448 Gailwood Cir N
Jacksonville, FL 32218-5286
Phone (904) 697-6464
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 84-4498219 | Other | FL | TRANPORTAION DRIVER |
| 84-4498219 | Medicaid | FL |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1580256000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1580256000000",
"number": "1417588336",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1448 GAILWOOD CIR N",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322185286",
"telephone_number": "904-697-6464"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1448 GAILWOOD CIR N",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322185286",
"telephone_number": "090-469-7646"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEONARD",
"first_name": "THEODORE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-01-29",
"last_updated": "2020-01-29",
"certification_date": "2020-01-29",
"status": "A"
},
"taxonomies": [
{
"code": "225XR0403X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Driving and Community Mobility",
"state": "FL",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRANPORTAION DRIVER",
"identifier": "84-4498219",
"state": "FL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "84-4498219",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.