MEDICARE: ALISON WEITMAN OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT003389	GA

General Provider Information

NPI Number	:	1558681361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISON WEITMAN OTR/L

Provider Business Mailing Address
First Line	:	710 MERGANSER CIR
Second Line	:
City	:	GLENNVILLE
State	:	GA
Zip	:	30427-2328
Country	:	US
Telephone Number	:	352-536-2561
Fax Number	:	407-264-6557

Provider Business Practice Location Address
First Line	:	816 FORESTWOOD DR
Second Line	:
City	:	MINNEOLA
State	:	FL
Zip	:	34715-7723
Country	:	US
Telephone Number	:	352-536-2561
Fax Number	:	407-264-6557

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2010
Last Update Date	:	06/03/2010

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