Provider Demographics
NPI:1134131709
Name:BUSH, ADRIANA D (OTR/L)
Entity type:Individual
Prefix:MS
First Name:ADRIANA
Middle Name:D
Last Name:BUSH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ADRIANA
Other - Middle Name:D
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:2279 A CR 314
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:TX
Mailing Address - Zip Code:79360-9355
Mailing Address - Country:US
Mailing Address - Phone:575-631-4701
Mailing Address - Fax:505-393-0249
Practice Address - Street 1:315 E CLINTON ST
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-8238
Practice Address - Country:US
Practice Address - Phone:505-393-0755
Practice Address - Fax:505-393-0249
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2084225X00000X
NMOT2084225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM41700074Medicaid