Individual
LARA VICTORIA LEACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
814 S WALNUT ST, STILLWATER, OK 74074-4225
(405) 377-8255
Mailing address
4514 CLASSEN CT, STILLWATER, OK 74075-1631
(405) 780-0172
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1922
OK
Other
Enumeration date
03/27/2018
Last updated
03/27/2018
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