NPIMap

Individual provider Active NPI

Leoncio King Menguito Geronimo, MOT, OTR/L

  • Occupational Therapist
  • Aurora, IL
National Provider Identifier
1942769278
Registry record updated Mar 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
056.12691 Issued in IL
Practice address
2021 Randi Dr
Aurora, IL 60504-4758
Phone
(630) 692-0450
NPI assigned
Mar 16, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 012691 IL
Occupational Therapist 225X00000X 056.12691 IL Primary

Addresses

Primary practice location

2021 Randi Dr
Aurora, IL 60504-4758

Mailing address

2171 W Executive Dr Ste 500
Addison, IL 60101-5626
Phone (630) 766-0505

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
012691ILMDOccupational Therapist
056.12691ILMDOccupational Therapist

NPI Registry JSON

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

{
    "created_epoch": "1552694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552694400000",
    "number": "1942769278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2171 W EXECUTIVE DR STE 500",
            "city": "ADDISON",
            "state": "IL",
            "postal_code": "601015626",
            "telephone_number": "630-766-0505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2021 RANDI DR",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605044758",
            "telephone_number": "630-692-0450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GERONIMO",
        "first_name": "LEONCIO KING",
        "middle_name": "MENGUITO",
        "name_prefix": "Mr.",
        "credential": "MOT, OTR/L",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-16",
        "last_updated": "2019-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IL",
            "license": "012691",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IL",
            "license": "056.12691",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Aurora, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 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.