Provider Demographics
NPI:1124216460
Name:LIELBRIEDIS, INDRA (OTR)
Entity Type:Individual
Prefix:MRS
First Name:INDRA
Middle Name:
Last Name:LIELBRIEDIS
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 1:802 BERKSHIRE DRIVE
Mailing Address - Street 2:
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176
Mailing Address - Country:US
Mailing Address - Phone:734-268-1045
Mailing Address - Fax:
Practice Address - Street 1:802 BERKSHIRE DR
Practice Address - Street 2:
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-1088
Practice Address - Country:US
Practice Address - Phone:734-268-1045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL416339004027171W00000X, 283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No283X00000XHospitalsRehabilitation Hospital