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NPI Code Detail

MEDICARE: MRS. LESLEY ANN DVORAK

MEDICARE: MRS. LESLEY ANN DVORAK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225C00000XRehabilitation Counselor

General Provider Information

NPI Number : 1669752176
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LESLEY ANN DVORAK
Provider Business Mailing Address
First Line : 1737 SALISBURY ST
Second Line :
City : ARDMORE
State : OK
Zip : 73401-1765
Country : US
Telephone Number : 580-221-4898
Fax Number : 580-223-2028
Provider Business Practice Location Address
First Line : 1301 KIOWA ST
Second Line :
City : ARDMORE
State : OK
Zip : 73401-2280
Country : US
Telephone Number : 580-226-9388
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2011
Last Update Date : 08/29/2011

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Directions to “ MRS. LESLEY ANN DVORAK ” Practice Location

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