Individual provider Active NPI

Timothy Livesay, OT

  • Occupational Therapist
  • East Syracuse, NY
National Provider Identifier
1699652354
Registry record updated Aug 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
030469 Issued in NY
Practice address
5823 Widewaters Pkwy Ste 3
East Syracuse, NY 13057-3081
Phone
(315) 418-4000
Fax
(315) 200-1802
NPI assigned
Aug 16, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2025

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 030469 NY Primary

Addresses

Primary practice location

5823 Widewaters Pkwy Ste 3
East Syracuse, NY 13057-3081

Mailing address

PO Box 580
Syracuse, NY 13214-0580
Phone (315) 418-4025

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250925003591 NY Practitioner - Occupational Therapist in Private Practice 7618472077 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

5823 Widewaters Pkwy
Suite 3
East Syracuse, NY 13057-3081
Phone (315) 418-4000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
030469NYMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Syracuse Orthopedic Specialists, PLLC CurrentSince Aug 14, 2025 Accepting new patients
Syracuse Orthopedic Specialists, PLLC PastSince Aug 14, 2025 Accepting new patients

Locations

5823 Widewaters Pkwy
Ste 3
East Syracuse, NY 13057
Phone (315) 418-4000

8324 Oswego Rd
Ste A
Liverpool, NY 13090
Phone (315) 418-4128

5719 Widewaters Pkwy
Syracuse, NY 13214
Phone (315) 251-3110

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": "1755302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755302400000",
    "number": "1699652354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 580",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132140580",
            "telephone_number": "315-418-4025",
            "fax_number": "315-552-6046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5823 WIDEWATERS PKWY STE 3",
            "city": "EAST SYRACUSE",
            "state": "NY",
            "postal_code": "130573081",
            "telephone_number": "315-418-4000",
            "fax_number": "315-200-1802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIVESAY",
        "first_name": "TIMOTHY",
        "credential": "OT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-08-16",
        "last_updated": "2025-08-16",
        "certification_date": "2025-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NY",
            "license": "030469",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Syracuse, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.