NPI 1205095239

Leroy Smith, COTA

Practitioner Contractor Suffolk, VA

Practice location

Address: 200 W Constance Rd, Suffolk, VA 23434-4413
Phone: (757) 539-8744
Fax: (757) 539-8764
Mailing address: 4413 Birch Rd, Portsmouth, VA 23703-1501

Registered specialties

Contractor Primary

Other Service Providers Taxonomy 171W00000X Licence 1008775 (VA)

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Registry record

NPI: 1205095239
Entity type: Individual
Sex (as registered): Male
NPI issued: 5 Jun 2008
Record last updated: 5 Jun 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.