Individual
MARSHA LEAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
VICE PRESIDENT
Contact information
Practice address
5724 STAGE RD STE F, BARTLETT, TN 38134-4572
(901) 383-0417
Mailing address
4630 ORANGE TULIP DR, MEMPHIS, TN 38135-0749
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000000000000
INDIVIDUAL
—
Enumeration date
10/05/2017
Last updated
10/05/2017
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