Healthcare Provider Details

I. General information

NPI: 1306868765
Provider Name (Legal Business Name): TERESA N LEIBFORTH OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 06/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 NE 10TH AVE
CRYSTAL RIVER FL
34429-4456
US

IV. Provider business mailing address

3803 NW 47TH TER
GAINESVILLE FL
32606-5992
US

V. Phone/Fax

Practice location:
  • Phone: 352-795-5552
  • Fax: 352-795-7751
Mailing address:
  • Phone: 352-376-5197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT 8392
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License NumberOT8392
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: