Healthcare Provider Details

I. General information

NPI: 1164666731
Provider Name (Legal Business Name): SARAH GRACE RUDNEY-LEIVA MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARAH GRACE RUDNEY-LEIVA MS, OTR/L

II. Dates (important events)

Enumeration Date: 04/27/2009
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 11
CROTON FALLS NY
10519-0011
US

IV. Provider business mailing address

PO BOX 11
CROTON FALLS NY
10519-0011
US

V. Phone/Fax

Practice location:
  • Phone: 315-278-5166
  • Fax:
Mailing address:
  • Phone: 315-278-5166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number010027-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: