MEDICARE: MAYDI MIRIAM LEIBOWITZ

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
1	225X00000X	Occupational Therapist	3942	CA

General Provider Information

NPI Number	:	1700229408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYDI MIRIAM LEIBOWITZ

Provider Business Mailing Address
First Line	:	13071 BROOKHURST ST
Second Line	:	SUITE 110
City	:	GARDEN GROVE
State	:	CA
Zip	:	92843-1091
Country	:	US
Telephone Number	:	714-636-7410
Fax Number	:

Provider Business Practice Location Address
First Line	:	13071 BROOKHURST ST
Second Line	:	STE 110
City	:	GARDEN GROVE
State	:	CA
Zip	:	92843-1091
Country	:	US
Telephone Number	:	714-636-7410
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2013
Last Update Date	:	04/11/2013

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