Healthcare Provider Details

I. General information

NPI: 1144191123
Provider Name (Legal Business Name): LEAH SAVIERA BRIONES-COOPER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 COUNTY ROUTE 64
MEXICO NY
13114-3229
US

IV. Provider business mailing address

4777 NEW HOPE S
LIVERPOOL NY
13090-2544
US

V. Phone/Fax

Practice location:
  • Phone: 315-963-0864
  • Fax:
Mailing address:
  • Phone: 315-963-0864
  • Fax: 315-963-7693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number030592
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: