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NPI Code Detail

MEDICARE: MRS. SHERRY LYNN LIEBERZ P.T.A.

MEDICARE: MRS. SHERRY LYNN LIEBERZ P.T.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171W00000XContractor693OK

General Provider Information

NPI Number : 1275741514
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SHERRY LYNN LIEBERZ P.T.A.
Provider Business Mailing Address
First Line : 736 MABLE FRY BLVD
Second Line :
City : YUKON
State : OK
Zip : 73099-2810
Country : US
Telephone Number : 405-354-8794
Fax Number : 405-721-2025
Provider Business Practice Location Address
First Line : 6525 N MERIDIAN AVE STE 311
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73116-1410
Country : US
Telephone Number : 405-721-1115
Fax Number : 405-721-2025
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2007
Last Update Date : 07/08/2007

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