Healthcare Provider Details

I. General information

NPI: 1558575258
Provider Name (Legal Business Name): CAPITALDISTRINCTHANDPHYISCALANDOCCUPATIONALTHERAPYSERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 NOTT ST STE 105A
SCHENECTADY NY
12308-2589
US

IV. Provider business mailing address

1201 NOTT ST STE 105A
SCHENECTADY NY
12308-2589
US

V. Phone/Fax

Practice location:
  • Phone: 518-377-9227
  • Fax: 518-377-2839
Mailing address:
  • Phone: 518-377-9227
  • Fax: 518-377-2839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number002636-1
License Number StateNY

VIII. Authorized Official

Name: RUTH ELIZABETH LEADLEY
Title or Position: OWNER
Credential:
Phone: 518-377-9227