Provider Demographics
NPI:1215246368
Name:LIEBMAN, MARJORIE EVE (OT)
Entity type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:EVE
Last Name:LIEBMAN
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 1:1391 2ND AVE
Mailing Address - Street 2:3C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4508
Mailing Address - Country:US
Mailing Address - Phone:212-570-2498
Mailing Address - Fax:
Practice Address - Street 1:1391 2ND AVE
Practice Address - Street 2:3C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4508
Practice Address - Country:US
Practice Address - Phone:212-570-2498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-06
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007388-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist