=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821490665
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEAH MERRILL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2014
-----------------------------------------------------
Last Update Date | 10/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10B MADISON AVENUE EXT
-----------------------------------------------------
City | ALBANY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12203-7314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-867-3061
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 71 2ND ST
-----------------------------------------------------
City | ATHENS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12015-1024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-945-1673
-----------------------------------------------------
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 | 029676
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------