Provider Demographics
NPI:1275741514
Name:LIEBERZ, SHERRY LYNN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:LYNN
Last Name:LIEBERZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 MABLE FRY BLVD
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-2810
Mailing Address - Country:US
Mailing Address - Phone:405-354-8794
Mailing Address - Fax:405-721-2025
Practice Address - Street 1:6525 N MERIDIAN AVE STE 311
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-1410
Practice Address - Country:US
Practice Address - Phone:405-721-1115
Practice Address - Fax:405-721-2025
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK693171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor