Provider Demographics
NPI:1457668444
Name:LEO, AMANDA VICTORIA (MOT, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:VICTORIA
Last Name:LEO
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:VICTORIA
Other - Last Name:KORNSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT, OTR/L
Mailing Address - Street 1:1157 FIRST COLONIAL RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-2432
Mailing Address - Country:US
Mailing Address - Phone:757-422-6342
Mailing Address - Fax:
Practice Address - Street 1:1157 FIRST COLONIAL RD
Practice Address - Street 2:SUITE 301
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-2432
Practice Address - Country:US
Practice Address - Phone:757-422-6342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-12
Last Update Date:2010-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119003492225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist