Provider Demographics
NPI:1114202371
Name:LIEBMAN, JILL MARA (OTR)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:MARA
Last Name:LIEBMAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 EAST DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-2102
Mailing Address - Country:US
Mailing Address - Phone:516-364-2584
Mailing Address - Fax:
Practice Address - Street 1:128 SHEPHERD ST
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-2257
Practice Address - Country:US
Practice Address - Phone:516-255-8928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002147-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist