Active NPI
Lakena Wiggins, OT
- Occupational Therapist
- Mansfield, TX
National Provider Identifier
1780111252
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 117069
- Practice address
- 1759 Broad Park Cir S Ste 113
Mansfield, TX 76063-7836 - Phone
- (817) 473-1312
- NPI assigned
- May 16, 2017
- 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 | 117069 | MS | Primary |
Addresses
Primary practice location
1759 Broad Park Cir S Ste 113
Mansfield, TX 76063-7836
Mailing address
4320 Dulles Dr
Fort Worth, TX 76155-3550
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 117069 | MS | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Synergy Care Southeast, LLC | Single Specialty | Current | Accepting new patients |
Locations
127 W Broad St
Ste 850
Lake Charles, LA 70601
Phone (337) 310-8500
Organizations & group practices 1
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": "1494892800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1494892800000",
"number": "1780111252",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4320 DULLES DR",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761553550"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1759 BROAD PARK CIR S STE 113",
"city": "MANSFIELD",
"state": "TX",
"postal_code": "760637836",
"telephone_number": "817-473-1312"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIGGINS",
"first_name": "LAKENA",
"credential": "OT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-05-16",
"last_updated": "2017-05-16",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Occupational Therapist",
"state": "MS",
"license": "117069",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mansfield, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.