Provider Demographics
NPI:1598000713
Name:LIEBEL, KELLEY ANN (OTR)
Entity Type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:ANN
Last Name:LIEBEL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:KELLEY
Other - Middle Name:ANN
Other - Last Name:KRESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:150 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:MORRISON
Mailing Address - State:CO
Mailing Address - Zip Code:80465-2532
Mailing Address - Country:US
Mailing Address - Phone:303-697-9714
Mailing Address - Fax:
Practice Address - Street 1:150 SPRING ST
Practice Address - Street 2:
Practice Address - City:MORRISON
Practice Address - State:CO
Practice Address - Zip Code:80465-2532
Practice Address - Country:US
Practice Address - Phone:303-697-9714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1302225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist