Individual provider Active NPI

Alexis Rose Kwasniewicz, MS, OTR/L

  • Occupational Therapist
  • Northville, MI
National Provider Identifier
1760157978
Registry record updated Aug 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
5201011363 Issued in MI
Practice address
44600 5 Mile Rd
Northville, MI 48168-9602
Phone
(248) 697-2900
NPI assigned
Aug 10, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2021

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 5201011363 MI Primary

Addresses

Primary practice location

44600 5 Mile Rd
Northville, MI 48168-9602

Mailing address

227 Osprey St
Walled Lake, MI 48390-3342
Phone (248) 421-8896

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210915000521 MI Practitioner - Occupational Therapist in Private Practice 9537565676 Reassigns benefits to 1 organization
I20250110000119 IL Practitioner - Occupational Therapist in Private Practice 9537565676 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
Western Michigan Un Homer Stryker School of Med, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Legacy Healthcare Services IncGroup PAC ID 2163339722, 3,431 clinicians

Practice addresses (Care Compare)

1865 E Belvidere Rd
Grayslake, IL 60030-2290
Phone (847) 986-4633

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Healthcare Services Inc Occupational Therapist CurrentSince Jan 6, 2025 Accepting new patients

Locations

110 Horizon Dr
Ste 310
Raleigh, NC 27615
Phone (970) 215-3300

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": "1628553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628553600000",
    "number": "1760157978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "227 OSPREY ST",
            "city": "WALLED LAKE",
            "state": "MI",
            "postal_code": "483903342",
            "telephone_number": "248-421-8896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44600 5 MILE RD",
            "city": "NORTHVILLE",
            "state": "MI",
            "postal_code": "481689602",
            "telephone_number": "248-697-2900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KWASNIEWICZ",
        "first_name": "ALEXIS",
        "middle_name": "ROSE",
        "credential": "MS, OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-10",
        "last_updated": "2021-08-10",
        "certification_date": "2021-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MI",
            "license": "5201011363",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Northville, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2021; 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.