Healthcare Provider Details

I. General information

NPI: 1235075631
Provider Name (Legal Business Name): LEAH CHARLSON PEDIATRIC OT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 MONTGOMERY AVE STE 307
PENN VALLEY PA
19072-1551
US

IV. Provider business mailing address

29 MERION RD
MERION STATION PA
19066-1826
US

V. Phone/Fax

Practice location:
  • Phone: 610-574-2683
  • Fax:
Mailing address:
  • Phone: 610-574-2683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. LEAH CHARLSON
Title or Position: DIRECTOR OF OCCUPATIONAL THERAPY
Credential: OTR/L
Phone: 610-574-2683