Provider Demographics
NPI:1154028116
Name:LIAKOS, LIZBETH ANNE
Entity type:Individual
Prefix:
First Name:LIZBETH
Middle Name:ANNE
Last Name:LIAKOS
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 1:333 BORTHWICK AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-4198
Mailing Address - Country:US
Mailing Address - Phone:603-433-5179
Mailing Address - Fax:
Practice Address - Street 1:333 BORTHWICK AVE STE 100
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-4198
Practice Address - Country:US
Practice Address - Phone:603-433-5110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1031225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist