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General NPI Number Information
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NPI Number | 1083265680
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Entity Type | Individual
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Provider Name | ALEXA DANIELLE LIBEROPOULOS OTR/L
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Gender | Female
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Dates
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Enumeration Date | 09/25/2019
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Last Update Date | 09/25/2019
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Provider Practice Location Address
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Address Line | 385 W CENTER ST
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City | MANCHESTER
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State | CT
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Zip | 06040-4797
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Country | US
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Telephone | 860-646-0129
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Fax |
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Provider Business Mailing Address
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Address Line | 702 BARBARA JEAN DR
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City | ENFIELD
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State | CT
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Zip | 06082-2187
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Country | US
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Telephone | 413-426-8731
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 5296
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License Number State | CT
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