=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396622866
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HADYN NICOLE SWAN-LEUZE OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2025
-----------------------------------------------------
Last Update Date | 08/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4108 MAIN ST
-----------------------------------------------------
City | ERIE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16511-1968
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-813-2759
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12 CRAWFORD LN
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14750-9635
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-969-2093
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 030329
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | OC020895
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------