Provider Demographics
NPI:1750829503
Name:LEACH, NAOMI
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:LEACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 S LARMON
Mailing Address - Street 2:433 S LARMAN
Mailing Address - City:COLCORD
Mailing Address - State:OK
Mailing Address - Zip Code:74338-5034
Mailing Address - Country:US
Mailing Address - Phone:918-326-4116
Mailing Address - Fax:
Practice Address - Street 1:433 S LARMON
Practice Address - Street 2:433 S LARMAN
Practice Address - City:COLCORD
Practice Address - State:OK
Practice Address - Zip Code:74338-5034
Practice Address - Country:US
Practice Address - Phone:918-326-4116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant