Provider Demographics
NPI:1992730782
Name:LEARY, ERIN COLLEEN (OTR/L)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:COLLEEN
Last Name:LEARY
Suffix:
Gender:F
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 1:2 DELAVERGNE AVE
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-1202
Mailing Address - Country:US
Mailing Address - Phone:845-297-4789
Mailing Address - Fax:845-297-8596
Practice Address - Street 1:2 DELAVERGNE AVE
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-1202
Practice Address - Country:US
Practice Address - Phone:845-297-4789
Practice Address - Fax:845-297-8596
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010982225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000414653001OtherHEALTH NOW
NY10107037OtherCDPHP
108374OtherOPERATING ENGINEERS LOCAL
NY831013OtherMANAGED PHYSICAL NETWORK
NY1171500OtherAETNA HMO
NY7853782OtherAETNA PPO, POS
NY374585OtherMVP
NYQU2441Medicare ID - Type UnspecifiedCMS MEDICARE PART B