Provider Demographics
NPI:1093450900
Name:SALA, LESLIE MORGAN
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:MORGAN
Last Name:SALA
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:PO BOX 817
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74076-0817
Mailing Address - Country:US
Mailing Address - Phone:405-743-1968
Mailing Address - Fax:405-743-1595
Practice Address - Street 1:608 W HIGHPOINT DR
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74075-1530
Practice Address - Country:US
Practice Address - Phone:405-743-1968
Practice Address - Fax:405-743-1595
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist