Healthcare Provider Details

I. General information

NPI: 1124216460
Provider Name (Legal Business Name): INDRA LIELBRIEDIS OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 BERKSHIRE DR
SALINE MI
48176-1088
US

IV. Provider business mailing address

802 BERKSHIRE DRIVE
SALINE MI
48176
US

V. Phone/Fax

Practice location:
  • Phone: 734-268-1045
  • Fax:
Mailing address:
  • Phone: 734-268-1045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License NumberL416339004027
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License NumberL416339004027
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: