Active NPI
Lacey Renee Wall, OTR
- Occupational Therapist
- Gadsden, AL
National Provider Identifier
1871522565
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 2153
- Practice address
- 1514 Owens St
Gadsden, AL 35904-4938 - Phone
- (256) 543-1030
- Fax
- (256) 439-2830
- NPI assigned
- Jul 3, 2006
- Sex
- Female
- Sole proprietor
- No
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 | 2153 | AL | Primary |
Addresses
Primary practice location
1514 Owens St
Gadsden, AL 35904-4938
Mailing address
1514 Owens St
Gadsden, AL 35904-4938
Phone (256) 543-1030
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 515-29758 | Other | AL | BLUE CROSS BLUE SHIELD |
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)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Complete Systems Inc | Past | Accepting new patients | |
| Occupational Therapy Services Unlimited LLC | Occupational Therapist | Past | Accepting new patients |
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.
-
- Parenteral & Enteral Nutrition Supplies (DME)
- Gadsden, AL
- NPI 1346337292
-
- Occupational Therapist
- Gadsden, AL
- NPI 1942310115
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151884800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1871522565",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1514 OWENS ST",
"city": "GADSDEN",
"state": "AL",
"postal_code": "359044938",
"telephone_number": "256-543-1030",
"fax_number": "256-439-2830"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1514 OWENS ST",
"city": "GADSDEN",
"state": "AL",
"postal_code": "359044938",
"telephone_number": "256-543-1030",
"fax_number": "256-439-2830"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALL",
"first_name": "LACEY",
"middle_name": "RENEE",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-03",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "AL",
"license": "2153",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "515-29758",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gadsden, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.