Individual
MS. OLIVIA RAE LEACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
73 WATERBURY RD, PROSPECT, CT 06712-1252
(203) 527-9444
(203) 527-9332
Mailing address
128 HILL ST, MERIDEN, CT 06450-2317
(518) 878-0183
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4480
CT
Other
Enumeration date
07/25/2019
Last updated
07/25/2019
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