Provider Demographics
NPI:1295216489
Name:LIEBELT, URSULA
Entity Type:Individual
Prefix:
First Name:URSULA
Middle Name:
Last Name:LIEBELT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:URSULA
Other - Middle Name:
Other - Last Name:FRAAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:414 HEATHER LN
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-3305
Mailing Address - Country:US
Mailing Address - Phone:650-576-9563
Mailing Address - Fax:
Practice Address - Street 1:600 SAND HILL RD
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-2630
Practice Address - Country:US
Practice Address - Phone:650-853-5028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6256225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist