Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | MT-08114 | AZ |
NPI | 1174956056 |
---|---|
Provider Name | Rebecca Lynn Leaf |
First Address | Silverdale, WA 98383-2733 |
Second Address | Silverdale, WA 98383-8089 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2013 |
Last Update Date | 15/08/2013 |