Healthcare Provider Details

I. General information

NPI: 1871164343
Provider Name (Legal Business Name): AMY PRYLE LEIVA OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMY ELIZABETH PRYLE OTR/L

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 07/06/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 52ND ST
OAKLAND CA
94609-1809
US

IV. Provider business mailing address

368 ELWORTHY RANCH CIR
DANVILLE CA
94526-4855
US

V. Phone/Fax

Practice location:
  • Phone: 510-428-3000
  • Fax:
Mailing address:
  • Phone: 510-333-9505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number12713
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: