Provider Demographics
NPI:1710213137
Name:PORTER, LESLIE DIANE (OTR/L)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:DIANE
Last Name:PORTER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 N POLK ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207-5328
Mailing Address - Country:US
Mailing Address - Phone:501-786-2800
Mailing Address - Fax:
Practice Address - Street 1:8023 INTERSTATE 30
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-4841
Practice Address - Country:US
Practice Address - Phone:501-374-0330
Practice Address - Fax:501-374-0395
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-19
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR2286225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics