Healthcare Provider Details

I. General information

NPI: 1275741514
Provider Name (Legal Business Name): SHERRY LYNN LIEBERZ P.T.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6525 N MERIDIAN AVE STE 311
OKLAHOMA CITY OK
73116-1410
US

IV. Provider business mailing address

736 MABLE FRY BLVD
YUKON OK
73099-2810
US

V. Phone/Fax

Practice location:
  • Phone: 405-721-1115
  • Fax: 405-721-2025
Mailing address:
  • Phone: 405-354-8794
  • Fax: 405-721-2025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number693
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: