Provider Demographics
NPI:1316039050
Name:KURKLIN, LEZLIE L (OT)
Entity Type:Individual
Prefix:MRS
First Name:LEZLIE
Middle Name:L
Last Name:KURKLIN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-2429
Mailing Address - Country:US
Mailing Address - Phone:432-267-3806
Mailing Address - Fax:432-267-3809
Practice Address - Street 1:306 W 3RD ST
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-2429
Practice Address - Country:US
Practice Address - Phone:432-267-3806
Practice Address - Fax:432-267-3809
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106213225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82191TOtherBLUE CROSS BLUE SHIELD