Provider Demographics
NPI:1881345759
Name:LIBERTORE, BRIANNA N (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:N
Last Name:LIBERTORE
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4575 WOODS CIR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44641-8430
Mailing Address - Country:US
Mailing Address - Phone:330-316-9273
Mailing Address - Fax:
Practice Address - Street 1:13719 DALLAS DR
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-7133
Practice Address - Country:US
Practice Address - Phone:727-862-6795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22158225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist