Provider Demographics
NPI:1609987460
Name:LEBER, SANDRA M (OTR)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:M
Last Name:LEBER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9721 ARBOR OAKS LN
Mailing Address - Street 2:#104
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-2206
Mailing Address - Country:US
Mailing Address - Phone:561-350-6112
Mailing Address - Fax:561-852-6835
Practice Address - Street 1:9721 ARBOR OAKS LN
Practice Address - Street 2:#104
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-2206
Practice Address - Country:US
Practice Address - Phone:561-350-6112
Practice Address - Fax:561-852-6835
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT10789225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL888914400Medicaid