Healthcare Provider Details

I. General information

NPI: 1699813527
Provider Name (Legal Business Name): ANNE THERESA LIEBER OTR L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 04/21/2023
Certification Date: 04/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 HARDING ST
WAUPACA WI
54981-2012
US

IV. Provider business mailing address

811 HARDING ST
WAUPACA WI
54981-2012
US

V. Phone/Fax

Practice location:
  • Phone: 715-258-6337
  • Fax:
Mailing address:
  • Phone: 314-541-6809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number001228
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number6423-26
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: