Individual
EBONE LEACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
9109 LIBERTY RD, RANDALLSTOWN, MD 21133-3521
(410) 655-7373
(601) 612-3052
Mailing address
9109 LIBERTY RD, RANDALLSTOWN, MD 21133-3521
(410) 655-7373
(610) 612-3052
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
A02651
MD
Other
Enumeration date
07/06/2018
Last updated
07/06/2018
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