Organization
PAT LEACH, OTR/L
Active
Other names
Pediatric Neuro Rehab Services
Organization subpart
No
Provider details
NPI number
Authorized official
MS. PATSY PENMAN LEACH OTR/L (PEDIATRIC OCCUPATIONAL THERAPIST)
(703) 242-1921
Entity
Organization
Contact information
Practice address
407 CHURCH ST NE, SUITE D, VIENNA, VA 22180-4737
(703) 242-1921
(703) 242-1922
Mailing address
407 CHURCH ST NE, SUITE D, VIENNA, VA 22180-4737
(703) 242-1921
(703) 242-1922
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
0119000736
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
075429639
TAX ID
VA
01
—
192718
INSURANCE PROVIDER NUMBER
VA
01
—
372912
PREFERRED PROVIDER NUMBER
VA
Enumeration date
10/23/2006
Last updated
07/01/2008
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