Individual
STACY LEACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
285 LINDEN DR, CENTERVILLE, OH 45459-4565
(937) 231-4694
Mailing address
285 LINDEN DR, CENTERVILLE, OH 45459-4565
(937) 231-4694
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
0358754
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0358754
—
OH
Enumeration date
09/24/2020
Last updated
09/24/2020
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