Provider Demographics
NPI:1053301630
Name:VANKERKHOVE, LESLIE LEGER (LOTR)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:LEGER
Last Name:VANKERKHOVE
Suffix:
Gender:F
Credentials:LOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-239-2018
Mailing Address - Fax:615-851-2018
Practice Address - Street 1:200 NW 66TH ST
Practice Address - Street 2:SUITE 900
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-8256
Practice Address - Country:US
Practice Address - Phone:405-804-1957
Practice Address - Fax:405-840-1052
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ12212225X00000X
OK1469225XH1200X
TN4097225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1115860Medicaid
LA721282530VAOtherHUMANA PROVIDER #
LA2314145OtherAETNA PROVIDER #