Provider Demographics
NPI:1841608098
Name:MAXFIELD, LIEAH (ATC)
Entity Type:Individual
Prefix:
First Name:LIEAH
Middle Name:
Last Name:MAXFIELD
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:MRS
Other - First Name:LIEAH
Other - Middle Name:
Other - Last Name:ZAVRID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:2824 W AVENUE N8
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-2457
Mailing Address - Country:US
Mailing Address - Phone:619-701-4256
Mailing Address - Fax:
Practice Address - Street 1:2824 W AVENUE N8
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-2457
Practice Address - Country:US
Practice Address - Phone:619-701-4256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-31
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABOC#20000121692255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer