Provider Demographics
NPI:1467698258
Name:LEAP OT, PT & SLP PLLC
Entity Type:Organization
Organization Name:LEAP OT, PT & SLP PLLC
Other - Org Name:LEAP FOR KIDS OT, PT & SLP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:MAURO
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC SLP
Authorized Official - Phone:585-797-9366
Mailing Address - Street 1:700 COTTAGE BROOK LN
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-8654
Mailing Address - Country:US
Mailing Address - Phone:585-797-9366
Mailing Address - Fax:585-486-1230
Practice Address - Street 1:700 COTTAGE BROOK LN
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-8654
Practice Address - Country:US
Practice Address - Phone:585-797-9366
Practice Address - Fax:585-486-1230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-28
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009318-1252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency