Provider Demographics
NPI:1881739803
Name:LEITCH, JEFF JAY
Entity type:Individual
Prefix:MR
First Name:JEFF
Middle Name:JAY
Last Name:LEITCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3224 CITADEL CT. S.E.
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98503-6221
Mailing Address - Country:US
Mailing Address - Phone:360-701-7684
Mailing Address - Fax:
Practice Address - Street 1:3224 CITADEL CT SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98503-6221
Practice Address - Country:US
Practice Address - Phone:360-701-7684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021368225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist