Provider Demographics
NPI:1063685055
Name:DEWBERRY, LIANA MARIE (OT)
Entity Type:Individual
Prefix:
First Name:LIANA
Middle Name:MARIE
Last Name:DEWBERRY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 NW EXPRESSWAY
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4418
Mailing Address - Country:US
Mailing Address - Phone:405-949-3277
Mailing Address - Fax:405-945-5898
Practice Address - Street 1:5300 N INDEPENDENCE AVE
Practice Address - Street 2:STE 120
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-5556
Practice Address - Country:US
Practice Address - Phone:405-951-8672
Practice Address - Fax:405-951-8203
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK406225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist