Provider Demographics
NPI:1386775906
Name:VAN LIESHOUT, BARBARA MARIE (MOTR, ATP)
Entity type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:MARIE
Last Name:VAN LIESHOUT
Suffix:
Gender:F
Credentials:MOTR, ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:WI
Mailing Address - Zip Code:53549-1184
Mailing Address - Country:US
Mailing Address - Phone:920-674-6069
Mailing Address - Fax:
Practice Address - Street 1:229 MEADOW CT
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:WI
Practice Address - Zip Code:53549-1184
Practice Address - Country:US
Practice Address - Phone:920-674-6339
Practice Address - Fax:920-674-6345
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI124-027246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other