Leah Tisdale

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

105939 Issued in MN

Practice address

2450 Riverside Ave
Minneapolis, MN 55454-1450

Phone

(612) 365-6777

NPI assigned

Jan 18, 2019

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Fairview Health Services

  dba Fairview Hospital University

  • General Acute Care Hospital
  • Minneapolis, MN
  • NPI 1013994359
  NPD (past)

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

{
    "created_epoch": "1547769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553040000000",
    "number": "1659845071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2544 CHRISTIAN PKWY",
            "city": "CHASKA",
            "state": "MN",
            "postal_code": "553181986",
            "telephone_number": "952-769-6441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2450 RIVERSIDE AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554541450",
            "telephone_number": "612-365-6777"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3400 W 66th St",
            "address_purpose": "LOCATION",
            "city": "Edina",
            "state": "MN",
            "postal_code": "554352111",
            "country_code": "US",
            "telephone_number": "952-914-1965",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2945 Hazelwood St Ste 320",
            "address_purpose": "LOCATION",
            "city": "Maplewood",
            "state": "MN",
            "postal_code": "551091244",
            "country_code": "US",
            "telephone_number": "651-683-7030",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9680 Tamarack Rd",
            "address_purpose": "LOCATION",
            "city": "Woodbury",
            "state": "MN",
            "postal_code": "551252622",
            "country_code": "US",
            "telephone_number": "651-265-7575",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TISDALE",
        "first_name": "LEAH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-18",
        "last_updated": "2019-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "MN",
            "license": "105939",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexis Tinnin
• Tiny Tree Counseling & Consulting LLC
• Clare Josephine Tipler
• Danielle Nichole Tippit, MD
• Ezgi Tiryaki, MD
• Roxanne Tisdale
• Sasha Marie Tisdell
• Anne Catherine Tita, M.D.
• Jamie Titus, D.C.
• Samuel Titus, DDS, MS

• Pediatric Occupational Therapist in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Pediatric Occupational Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 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.