Provider Demographics
NPI:1063937563
Name:LEIBHAM, BRITTNEY
Entity type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:
Last Name:LEIBHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11667 LITTLE RIVER WAY
Mailing Address - Street 2:
Mailing Address - City:PARRISH
Mailing Address - State:FL
Mailing Address - Zip Code:34219-3234
Mailing Address - Country:US
Mailing Address - Phone:630-209-9003
Mailing Address - Fax:
Practice Address - Street 1:11667 LITTLE RIVER WAY
Practice Address - Street 2:
Practice Address - City:PARRISH
Practice Address - State:FL
Practice Address - Zip Code:34219-3234
Practice Address - Country:US
Practice Address - Phone:630-209-9003
Practice Address - Fax:630-209-9003
Is Sole Proprietor?:No
Enumeration Date:2017-08-07
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056012053225X00000X
FL22428225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist