Healthcare Provider Details

I. General information

NPI: 1093218620
Provider Name (Legal Business Name): HANNAH ROSE LYBARGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2018
Last Update Date: 11/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31918 US HIGHWAY 19 N
PALM HARBOR FL
34684
US

IV. Provider business mailing address

31918 US HIGHWAY 19 N
PALM HARBOR FL
34684-3730
US

V. Phone/Fax

Practice location:
  • Phone: 727-303-9200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number18643
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: