Provider Demographics
NPI:1386791754
Name:LIEPELT, ERICA JOHANNA (OTR, CHT)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:JOHANNA
Last Name:LIEPELT
Suffix:
Gender:F
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 82564
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97282-0564
Mailing Address - Country:US
Mailing Address - Phone:503-229-8300
Mailing Address - Fax:
Practice Address - Street 1:5331 SW MACADAM AVE
Practice Address - Street 2:SUITE 277
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-6104
Practice Address - Country:US
Practice Address - Phone:503-229-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR969795225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand