Provider Demographics
NPI:1871645069
Name:DUDDING, LEIGH (MS OTR L)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:
Last Name:DUDDING
Suffix:
Gender:F
Credentials:MS OTR L
Other - Prefix:
Other - First Name:LEIGH
Other - Middle Name:
Other - Last Name:MAJER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS OTR L
Mailing Address - Street 1:423 CONNECTICUT AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23508-2703
Mailing Address - Country:US
Mailing Address - Phone:215-605-1707
Mailing Address - Fax:
Practice Address - Street 1:1400 FORDHAM DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-5368
Practice Address - Country:US
Practice Address - Phone:757-361-3954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119002287225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4980701Medicaid
VA4980701Medicaid