Provider Demographics
NPI:1649353483
Name:PAT LEACH, OTR/L
Entity type:Organization
Organization Name:PAT LEACH, OTR/L
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:PATSY
Authorized Official - Middle Name:PENMAN
Authorized Official - Last Name:LEACH
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:703-242-1921
Mailing Address - Street 1:407 CHURCH ST NE
Mailing Address - Street 2:SUITE D
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4737
Mailing Address - Country:US
Mailing Address - Phone:703-242-1921
Mailing Address - Fax:703-242-1922
Practice Address - Street 1:407 CHURCH ST NE
Practice Address - Street 2:SUITE D
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4737
Practice Address - Country:US
Practice Address - Phone:703-242-1921
Practice Address - Fax:703-242-1922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119000736225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA372912OtherPREFERRED PROVIDER NUMBER
VA075429639OtherTAX ID
VA192718OtherINSURANCE PROVIDER NUMBER