Provider Demographics
NPI:1962096941
Name:LIBURD, TAMARA FELICIA
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:FELICIA
Last Name:LIBURD
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 1:15000 W AIRPORT BLVD APT 331
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-7246
Mailing Address - Country:US
Mailing Address - Phone:832-716-6003
Mailing Address - Fax:
Practice Address - Street 1:504 BERING DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-1479
Practice Address - Country:US
Practice Address - Phone:832-699-1767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-21
Last Update Date:2021-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113920225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist