Provider Demographics
NPI:1316643299
Name:LESLIE PORTER, INC
Entity type:Organization
Organization Name:LESLIE PORTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:501-786-2800
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 1:1624 N POLK ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207-5328
Practice Address - Country:US
Practice Address - Phone:501-786-2800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR180492721Medicaid