Basic Information
| Provider Information | |||||||||
| NPI: | 1306332184 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OLIVER | ||||||||
| FirstName: | LEAH | ||||||||
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| Credential: | M.S., OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7000 AUSTIN ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | FOREST HILLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113754739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187627633 | ||||||||
| FaxNumber: | 7188868694 | ||||||||
| Practice Location | |||||||||
| Address1: | 7000 AUSTIN ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | FOREST HILLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113754739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187627633 | ||||||||
| FaxNumber: | 7188868694 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2018 | ||||||||
| LastUpdateDate: | 07/05/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 022640 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 401876 | 01 | NBCOT REGISTRATION | OTHER | 022640 | 01 | NY | OCCUPATIONAL THERAPY LICENSE LUMBER | OTHER |