Provider Demographics
NPI:1679989685
Name:SIEBERT, MARIE (OTR)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:SIEBERT
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 1:3208 LONG PRAIRIE RD
Mailing Address - Street 2:D
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-2718
Mailing Address - Country:US
Mailing Address - Phone:972-874-9400
Mailing Address - Fax:972-221-6438
Practice Address - Street 1:3208 LONG PRAIRIE RD
Practice Address - Street 2:D
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-2718
Practice Address - Country:US
Practice Address - Phone:972-874-9400
Practice Address - Fax:972-221-6438
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108497225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist