Provider Demographics
NPI:1629366364
Name:LEON, ERICK (OTR/L)
Entity Type:Individual
Prefix:
First Name:ERICK
Middle Name:
Last Name:LEON
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 BAINBRIDGE AVE
Mailing Address - Street 2:5B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-3425
Mailing Address - Country:US
Mailing Address - Phone:646-546-8646
Mailing Address - Fax:
Practice Address - Street 1:2800 BAINBRIDGE AVE
Practice Address - Street 2:5B
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-3425
Practice Address - Country:US
Practice Address - Phone:646-546-8646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-15
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016802225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist