Provider Demographics
NPI:1821187766
Name:LIEBERT, GERI (OT)
Entity Type:Individual
Prefix:
First Name:GERI
Middle Name:
Last Name:LIEBERT
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 EMBARCADERO DR
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-4087
Mailing Address - Country:US
Mailing Address - Phone:916-933-1221
Mailing Address - Fax:916-933-0871
Practice Address - Street 1:907 EMBARCADERO DR
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-4087
Practice Address - Country:US
Practice Address - Phone:916-933-1221
Practice Address - Fax:916-933-0871
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT2576225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ30971ZMedicare ID - Type UnspecifiedMEDICARE