Provider Demographics
NPI:1558534834
Name:LEESEBERG, MARILYN JOY (MT-BC, MMT)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:JOY
Last Name:LEESEBERG
Suffix:
Gender:F
Credentials:MT-BC, MMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 E ARGYLE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-2657
Mailing Address - Country:US
Mailing Address - Phone:301-838-0289
Mailing Address - Fax:
Practice Address - Street 1:10 E ARGYLE ST
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-2657
Practice Address - Country:US
Practice Address - Phone:301-838-0289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist