Healthcare Provider Details

I. General information

NPI: 1477475101
Provider Name (Legal Business Name): STEPHANIE JAMES LIEBENROOD OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 TARRAR SPRINGS RD
LEXINGTON SC
29072-3835
US

IV. Provider business mailing address

332 MONTROSE DR
LEXINGTON SC
29072-6506
US

V. Phone/Fax

Practice location:
  • Phone: 803-821-1000
  • Fax:
Mailing address:
  • Phone: 864-363-3112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number2545
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: