Healthcare Provider Details

I. General information

NPI: 1366779720
Provider Name (Legal Business Name): BARBARA M WEISS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2009
Last Update Date: 11/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 HASSON ST
FARMINGDALE ME
04344-1613
US

IV. Provider business mailing address

10 PROSPECT ST
AUGUSTA ME
04330-5026
US

V. Phone/Fax

Practice location:
  • Phone: 207-582-8400
  • Fax: 207-582-8401
Mailing address:
  • Phone: 207-242-0648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOA2147
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: