Provider Demographics
NPI:1144592635
Name:SANDERS, LELA LATRESE
Entity Type:Individual
Prefix:
First Name:LELA
Middle Name:LATRESE
Last Name:SANDERS
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 1:2523 E 88TH ST
Mailing Address - Street 2:APT. 314
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-2423
Mailing Address - Country:US
Mailing Address - Phone:281-743-7911
Mailing Address - Fax:
Practice Address - Street 1:2448 E 81ST ST
Practice Address - Street 2:SUITE 4824
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-4250
Practice Address - Country:US
Practice Address - Phone:918-392-7875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-31
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner