Provider Demographics
NPI:1902149602
Name:LIEBERMAN, JESSICA MAUREEN (OTR)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MAUREEN
Last Name:LIEBERMAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 MEWS LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-1748
Mailing Address - Country:US
Mailing Address - Phone:973-327-4066
Mailing Address - Fax:908-580-3837
Practice Address - Street 1:9000 FELLOWSHIP RD
Practice Address - Street 2:
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-3912
Practice Address - Country:US
Practice Address - Phone:908-580-3827
Practice Address - Fax:908-580-3837
Is Sole Proprietor?:No
Enumeration Date:2013-04-01
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00470700225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist