Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | Z12212 | LA |
N | 225XH1200X | Occupational Therapist - Hand | 1469 | OK |
NPI | 1053301630 |
---|---|
Provider Name | Mrs. Leslie Leger Vankerkhove |
First Address | Edmond, OK 73003-2245 |
Second Address | Oklahoma City, OK 73116-8256 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1115860 | (05) | LA |
2314145 | AETNA PROVIDER # (01) | LA |
721282530VA | HUMANA PROVIDER # (01) | LA |