1033187083 NPI number — MRS. KAREN HELEN LIBERI KAREN LIBERI

Table of content: MRS. KAREN HELEN LIBERI KAREN LIBERI (NPI 1033187083)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033187083 NPI number — MRS. KAREN HELEN LIBERI KAREN LIBERI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIBERI
Provider First Name:
KAREN
Provider Middle Name:
HELEN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
KAREN LIBERI
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SULLIVAN
Provider Other First Name:
KAREN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, MPT, WCS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1033187083
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6005 MONCLOVA RD STE 320
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAUMEE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43537-1862
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3806 HILLSIDE CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ADRIAN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49221-9013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-759-4921
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT013275 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X , with the licence number: 5501014541 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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