Provider Demographics
NPI:1700461597
Name:SHELTON, LESLEY N (COTA)
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:N
Last Name:SHELTON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:NIKKI
Other - Middle Name:
Other - Last Name:SHELTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COTA
Mailing Address - Street 1:1115 TOKALON RD
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:AR
Mailing Address - Zip Code:72863-9236
Mailing Address - Country:US
Mailing Address - Phone:479-438-1481
Mailing Address - Fax:
Practice Address - Street 1:1115 TOKALON RD
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:AR
Practice Address - Zip Code:72863-9236
Practice Address - Country:US
Practice Address - Phone:479-438-1481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A1697224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant