Provider Demographics
NPI:1821395393
Name:LALIBERTE, TODD ALAN (OTR/L)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:ALAN
Last Name:LALIBERTE
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 SAULS ST STE B
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:SC
Mailing Address - Zip Code:29560-2677
Mailing Address - Country:US
Mailing Address - Phone:843-374-0185
Mailing Address - Fax:843-374-0189
Practice Address - Street 1:610 W PALMETTO ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4302
Practice Address - Country:US
Practice Address - Phone:843-407-0377
Practice Address - Fax:843-799-1944
Is Sole Proprietor?:No
Enumeration Date:2011-02-18
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC563225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist