Provider Demographics
NPI:1730908625
Name:NEIBERLINE, SANDRA MARIE
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:MARIE
Last Name:NEIBERLINE
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 1:6576 TARLTON RD
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-9468
Mailing Address - Country:US
Mailing Address - Phone:740-649-0146
Mailing Address - Fax:
Practice Address - Street 1:6576 TARLTON RD
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-9468
Practice Address - Country:US
Practice Address - Phone:740-649-0146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician