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General NPI Number Information
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NPI Number | 1255892006
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Entity Type | Individual
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Provider Name | MICHAELA LEATHERWOOD OTR/L
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Gender | Female
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Dates
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Enumeration Date | 03/26/2019
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Last Update Date | 04/26/2025
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Provider Practice Location Address
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Address Line | 3925 DOWNS DR
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City | CHANTILLY
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State | VA
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Zip | 20151-3308
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Country | US
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Telephone | 877-407-3422
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Fax | 877-407-4329
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Provider Business Mailing Address
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Address Line | 71 LESUEUR ST
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City | DILLWYN
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State | VA
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Zip | 23936-2450
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Country | US
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Telephone | 434-391-4412
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 0119-008014
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License Number State | VA
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