MEDICARE: ERINN VICTORIA LEIB MOT, OTR/L

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	TOC101218	OTHER	PA	TEMPORARY LICENCE FOR OT
2	OC010418	OTHER	PA	COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF STATE

General Provider Information

NPI Number	:	1871601260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERINN VICTORIA LEIB MOT, OTR/L

Provider Business Mailing Address
First Line	:	34 NOBLE DR
Second Line	:
City	:	SHIPPENSBURG
State	:	PA
Zip	:	17257-8862
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2998 LUTHER DR
Second Line	:
City	:	CHAMBERSBURG
State	:	PA
Zip	:	17202-7040
Country	:	US
Telephone Number	:	717-264-5700
Fax Number	:

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

Provider Enumeration Date	:	08/27/2006
Last Update Date	:	11/09/2020

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