Provider Demographics
NPI:1376768523
Name:CAPITAL DISTRICT HAND PHYSICAL AND OCCUPATIONAL THERAPY SERVICES PLLC
Entity Type:Organization
Organization Name:CAPITAL DISTRICT HAND PHYSICAL AND OCCUPATIONAL THERAPY SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:LEADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:OTR,CHT
Authorized Official - Phone:518-377-9227
Mailing Address - Street 1:1201 NOTT ST STE 105A
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12308-2589
Mailing Address - Country:US
Mailing Address - Phone:518-377-9227
Mailing Address - Fax:
Practice Address - Street 1:1201 NOTT ST STE 105A
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-2589
Practice Address - Country:US
Practice Address - Phone:518-377-9227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-14
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002636-1225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY22XH1200XOtherPROVIDER TAXONMIES
NYBA0080Medicare PIN
NYP00381335Medicare PIN
NYDF6414Medicare PIN
NYRA0665Medicare PIN
NY22XH1200XOtherPROVIDER TAXONMIES