Provider Demographics
NPI:1639762966
Name:OREL LIEBER, ELENA VLADIMIROVNA
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:VLADIMIROVNA
Last Name:OREL LIEBER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2581 25TH LOOP SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-3812
Mailing Address - Country:US
Mailing Address - Phone:360-561-4499
Mailing Address - Fax:
Practice Address - Street 1:1017 4TH AVE E
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-4016
Practice Address - Country:US
Practice Address - Phone:360-539-7726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61121766225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist