Provider Demographics
NPI:1982267076
Name:WOOTEN, WHITNEY LEIGH (OTR/L)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:LEIGH
Last Name:WOOTEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:WHITNEY
Other - Middle Name:LEIGH
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:64 EDWARDS CT.
Mailing Address - Street 2:
Mailing Address - City:DUTTON
Mailing Address - State:VA
Mailing Address - Zip Code:23050
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6688 MAIN ST
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:VA
Practice Address - Zip Code:23061-5194
Practice Address - Country:US
Practice Address - Phone:804-210-1555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-15
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119007597225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty