Provider Demographics
NPI:1851501217
Name:ENTREKIN, LESLIE RENEE (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:RENEE
Last Name:ENTREKIN
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 MOON RD
Mailing Address - Street 2:
Mailing Address - City:MULBERRY
Mailing Address - State:AR
Mailing Address - Zip Code:72947-8359
Mailing Address - Country:US
Mailing Address - Phone:479-670-2253
Mailing Address - Fax:
Practice Address - Street 1:6301 MOON RD
Practice Address - Street 2:
Practice Address - City:MULBERRY
Practice Address - State:AR
Practice Address - Zip Code:72947-8359
Practice Address - Country:US
Practice Address - Phone:479-670-2252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR762174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist