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General NPI Number Information
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NPI Number | 1316131055
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Entity Type | Individual
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Provider Name | ANTHONY JOSEPH LEO O.T.R.
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Gender | Male
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Dates
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Enumeration Date | 09/05/2007
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Last Update Date | 09/05/2007
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Provider Practice Location Address
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Address Line | 601 CHILDRENS LN
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City | NORFOLK
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State | VA
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Zip | 23507-1910
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Country | US
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Telephone | 757-668-7418
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Fax | 757-668-9111
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Provider Business Mailing Address
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Address Line | 1704 BURROUGHS RD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23455-4314
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Country | US
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Telephone | 757-226-0847
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Fax | 757-226-0847
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 0119003485
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License Number State | VA
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