Healthcare Provider Details

I. General information

NPI: 1710044177
Provider Name (Legal Business Name): HELENE ANN LIEBERMAN MS, OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HELENE ANN THAU

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 08/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 E ORCHARD CIR
DAVIE FL
33328-6792
US

IV. Provider business mailing address

PO BOX 290370
FT LAUDERDALE FL
33329-0370
US

V. Phone/Fax

Practice location:
  • Phone: 954-236-0806
  • Fax:
Mailing address:
  • Phone: 954-262-4346
  • Fax: 954-262-2269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT 2267
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: