Provider Demographics
NPI:1548344013
Name:LEO, STEPHEN VINCENT (OTR, CHT)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:VINCENT
Last Name:LEO
Suffix:
Gender:M
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 MACTANLY PL
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-2372
Mailing Address - Country:US
Mailing Address - Phone:540-885-1177
Mailing Address - Fax:540-885-5856
Practice Address - Street 1:107 MACTANLY PL
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401
Practice Address - Country:US
Practice Address - Phone:540-885-1177
Practice Address - Fax:540-885-5856
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119000943225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC08501858OtherMEDICARE-DME JURS C
VA300416472OtherEIN NUMBER
VAP74685Medicare UPIN
VAC10291Medicare PIN
VAC08501858OtherMEDICARE-DME JURS C