Provider Demographics
NPI:1356970297
Name:LIBRANDI, MARIAH LYNN
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:LYNN
Last Name:LIBRANDI
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 1:49 GROFF RD
Mailing Address - Street 2:
Mailing Address - City:ANNVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17003-8531
Mailing Address - Country:US
Mailing Address - Phone:717-439-8553
Mailing Address - Fax:
Practice Address - Street 1:49 GROFF RD
Practice Address - Street 2:
Practice Address - City:ANNVILLE
Practice Address - State:PA
Practice Address - Zip Code:17003-8531
Practice Address - Country:US
Practice Address - Phone:717-439-8553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC016861225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics