Provider Demographics
NPI:1679928329
Name:LIBRA, STEPHANIE (OCCUPATIONAL THERAPI)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:LIBRA
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BARBER PLACE
Mailing Address - Street 2:BOX # 29
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507
Mailing Address - Country:US
Mailing Address - Phone:814-453-7661
Mailing Address - Fax:814-874-5642
Practice Address - Street 1:100 BARBER PLACE
Practice Address - Street 2:BOX # 29
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507
Practice Address - Country:US
Practice Address - Phone:814-453-7661
Practice Address - Fax:814-874-5642
Is Sole Proprietor?:No
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC014353225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist