Provider Demographics
NPI:1932405941
Name:GRAHAM, AMY LEIGH (OTR/L)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LEIGH
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 MARSH DUCK WAY
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-6559
Mailing Address - Country:US
Mailing Address - Phone:540-580-7941
Mailing Address - Fax:
Practice Address - Street 1:5544 GREENWICH RD
Practice Address - Street 2:STE 300
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6563
Practice Address - Country:US
Practice Address - Phone:757-499-2303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-09
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119005323225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist