Provider Demographics
NPI:1104321033
Name:WILES, VERONICA LEIGH (OT/L)
Entity type:Individual
Prefix:MRS
First Name:VERONICA
Middle Name:LEIGH
Last Name:WILES
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10303 SLIDINGROCK DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-8723
Mailing Address - Country:US
Mailing Address - Phone:804-366-1544
Mailing Address - Fax:
Practice Address - Street 1:301 NORTH 9TH STREET
Practice Address - Street 2:EXCEPTIONAL EDUCATION
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219
Practice Address - Country:US
Practice Address - Phone:804-780-7312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119000763225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics