Provider Demographics
NPI:1427592377
Name:LEIBRICH, AMBER (OTA/L)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:LEIBRICH
Suffix:
Gender:F
Credentials:OTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5120 SAINT MORITZ DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55421-1344
Mailing Address - Country:US
Mailing Address - Phone:651-353-0397
Mailing Address - Fax:
Practice Address - Street 1:3700 FOSS RD
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55421-4512
Practice Address - Country:US
Practice Address - Phone:612-788-9673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN202100224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant