Provider Demographics
NPI:1598236150
Name:LUEBBERS, MARIA NICOLE (OTR)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:NICOLE
Last Name:LUEBBERS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:NICOLE
Other - Last Name:KLOSTERMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:905 MADDY
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:IL
Mailing Address - Zip Code:62245-2063
Mailing Address - Country:US
Mailing Address - Phone:618-975-2381
Mailing Address - Fax:
Practice Address - Street 1:1207 VANDALIA ST
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-4092
Practice Address - Country:US
Practice Address - Phone:618-215-5315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.012757225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist