Provider Demographics
NPI:1508420142
Name:LEGGETT, BRIANNA N (COTA /L)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:N
Last Name:LEGGETT
Suffix:
Gender:F
Credentials:COTA /L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1581 PENROSE ARCH
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23453-1551
Mailing Address - Country:US
Mailing Address - Phone:757-748-6387
Mailing Address - Fax:
Practice Address - Street 1:516 GREAT BRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-7034
Practice Address - Country:US
Practice Address - Phone:757-447-0511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131001644224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant