1649353483 NPI number — PAT LEACH, OTR/L

Table of content: (NPI 1649353483)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649353483 NPI number — PAT LEACH, OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAT LEACH, OTR/L
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PEDIATRIC NEURO REHAB SERVICES
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649353483
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
407 CHURCH ST NE
Provider Second Line Business Mailing Address:
SUITE D
Provider Business Mailing Address City Name:
VIENNA
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22180-4737
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-242-1921
Provider Business Mailing Address Fax Number:
703-242-1922

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
407 CHURCH ST NE
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
VIENNA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22180-4737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-242-1921
Provider Business Practice Location Address Fax Number:
703-242-1922
Provider Enumeration Date:
10/23/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LEACH
Authorized Official First Name:
PATSY
Authorized Official Middle Name:
PENMAN
Authorized Official Title or Position:
PEDIATRIC OCCUPATIONAL THERAPIST
Authorized Official Telephone Number:
703-242-1921

Provider Taxonomy Codes

  • Taxonomy code: 225XP0200X , with the licence number:  0119000736 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 372912 . This is a "PREFERRED PROVIDER NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 075429639 . This is a "TAX ID" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 192718 . This is a "INSURANCE PROVIDER NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".