Provider Demographics
NPI:1437485026
Name:LIBONATI, BRIAN E (OTR/L)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:E
Last Name:LIBONATI
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1718 SEARAY LN
Mailing Address - Street 2:
Mailing Address - City:CAROLINA BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28428-5621
Mailing Address - Country:US
Mailing Address - Phone:910-458-2779
Mailing Address - Fax:
Practice Address - Street 1:1718 SEARAY LN
Practice Address - Street 2:
Practice Address - City:CAROLINA BEACH
Practice Address - State:NC
Practice Address - Zip Code:28428-5621
Practice Address - Country:US
Practice Address - Phone:910-458-2779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-02
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4294174400000X
HIOT1126225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No174400000XOther Service ProvidersSpecialist