Healthcare Provider Details

I. General information

NPI: 1902149602
Provider Name (Legal Business Name): JESSICA MAUREEN LIEBERMAN OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2013
Last Update Date: 04/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 FELLOWSHIP RD
BASKING RIDGE NJ
07920-3912
US

IV. Provider business mailing address

70 MEWS LN
SOUTH ORANGE NJ
07079-1748
US

V. Phone/Fax

Practice location:
  • Phone: 908-580-3827
  • Fax: 908-580-3837
Mailing address:
  • Phone: 973-327-4066
  • Fax: 908-580-3837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number46TR00470700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: