Healthcare Provider Details

I. General information

NPI: 1871645069
Provider Name (Legal Business Name): LEIGH DUDDING MS OTR L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEIGH MAJER MS OTR L

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 FORDHAM DR
VIRGINIA BEACH VA
23464-5368
US

IV. Provider business mailing address

423 CONNECTICUT AVE
NORFOLK VA
23508-2703
US

V. Phone/Fax

Practice location:
  • Phone: 757-361-3954
  • Fax:
Mailing address:
  • Phone: 215-605-1707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119002287
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: