Provider Demographics
NPI:1811243439
Name:LIEBROSS, SUSAN (OT)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:LIEBROSS
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 1:1170 COUNTY ROAD 519
Mailing Address - Street 2:
Mailing Address - City:FRENCHTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08825-4151
Mailing Address - Country:US
Mailing Address - Phone:908-581-6257
Mailing Address - Fax:
Practice Address - Street 1:20 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:FRENCHTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08825-1227
Practice Address - Country:US
Practice Address - Phone:908-581-6257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00038000225X00000X, 225XF0002X, 225XN1300X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistFeeding, Eating & Swallowing
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation