Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1225357890 |
---|---|
Provider Name | Kerron Andrew Leache |
First Address | Oklahoma City, OK 73120-1758 |
Second Address | Oklahoma City, OK 73120-1758 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2010 |
Last Update Date | 21/05/2010 |