Provider Demographics
NPI:1821110164
Name:KRUSH LIES, BARB L (OTRL)
Entity Type:Individual
Prefix:MS
First Name:BARB
Middle Name:L
Last Name:KRUSH LIES
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5530 18 ST NE
Mailing Address - Street 2:
Mailing Address - City:CATHAY
Mailing Address - State:ND
Mailing Address - Zip Code:58422
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16 SOUTH 8TH
Practice Address - Street 2:
Practice Address - City:NEW ROCKFORD
Practice Address - State:ND
Practice Address - Zip Code:58356-1520
Practice Address - Country:US
Practice Address - Phone:701-947-5018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND196225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist