Provider Demographics
NPI:1750788196
Name:DELONG-LIEB, BARBARA
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:DELONG-LIEB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OH
Mailing Address - Zip Code:44906-1787
Mailing Address - Country:US
Mailing Address - Phone:419-520-2386
Mailing Address - Fax:419-529-3515
Practice Address - Street 1:2011 W 4TH ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OH
Practice Address - Zip Code:44906-1787
Practice Address - Country:US
Practice Address - Phone:419-520-2386
Practice Address - Fax:419-529-3515
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT001059225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHOT001059Medicaid