Individual
TERESA L LEATHERLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CST
Contact information
Practice address
904 SOUTH ST, LAFAYETTE, IN 47901-1416
(765) 742-2441
(765) 742-2344
Mailing address
PO BOX 4699, LAFAYETTE, IN 47903-4699
(765) 742-2441
(765) 742-2344
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
102773
IN
Other
Enumeration date
04/16/2007
Last updated
07/08/2007
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