Provider Demographics
NPI:1891682746
Name:LEICHTMAN, GRAYSON (OTR/L)
Entity type:Individual
Prefix:
First Name:GRAYSON
Middle Name:
Last Name:LEICHTMAN
Suffix:
Gender:X
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:567 BAY RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03824-3440
Mailing Address - Country:US
Mailing Address - Phone:603-988-8938
Mailing Address - Fax:
Practice Address - Street 1:10 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03839-5227
Practice Address - Country:US
Practice Address - Phone:603-332-6487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3417225X00000X
NY030179225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist