Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 46TR00038000 | NJ |
N | 225XF0002X | Feeding, Eating & Swallowing | 46TR00038000 | NJ |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 46TR00038000 | NJ |
N | 225XP0200X | Occupational Therapist - Pediatrics | 46TR00038000 | NJ |
NPI | 1811243439 |
---|---|
Provider Name | Mrs. Susan Liebross |
First Address | Frenchtown, NJ 08825-4151 |
Second Address | Warren, NJ 07059-5120 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2012 |
Last Update Date | 01/08/2012 |