Active NPI
Leslie Gavin
- Occupational Therapist
- Fort Worth, TX
National Provider Identifier
1659618445
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 305161
- Practice address
- 1000 Saint Louis Ave
Suite 102
Fort Worth, TX 76104-3366 - Phone
- (817) 921-5020
- Fax
- (817) 789-6849
- NPI assigned
- Jan 14, 2013
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 305161 | TX | Primary |
Addresses
Primary practice location
1000 Saint Louis Ave
Suite 102
Fort Worth, TX 76104-3366
Mailing address
5316 Trail Lake Dr
Fort Worth, TX 76133-1931
Phone (817) 292-8787
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 149984001 | Medicaid | TX | |
| 207164901 | Medicaid | TX |
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 |
|---|---|---|---|
| 305161 | TX | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1358121600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1605139200000",
"number": "1659618445",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5316 TRAIL LAKE DR",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761331931",
"telephone_number": "817-292-8787",
"fax_number": "817-789-6849"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 SAINT LOUIS AVE",
"address_2": "SUITE 102",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761043366",
"telephone_number": "817-921-5020",
"fax_number": "817-789-6849"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GAVIN",
"first_name": "LESLIE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-01-14",
"last_updated": "2020-11-12",
"certification_date": "2020-11-12",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "TX",
"license": "305161",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "149984001",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "207164901",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 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.