Healthcare Provider Details

I. General information

NPI: 1457852279
Provider Name (Legal Business Name): MARILYN LOUISE LEIBY OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2018
Last Update Date: 02/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 BEECH ST
CHARLOTTE MI
48813-1016
US

IV. Provider business mailing address

1264 S ROYSTON RD
EATON RAPIDS MI
48827-9091
US

V. Phone/Fax

Practice location:
  • Phone: 517-543-2940
  • Fax:
Mailing address:
  • Phone: 517-256-1950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201000951
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: