Healthcare Provider Details

I. General information

NPI: 1508168501
Provider Name (Legal Business Name): SALLY WEISBERG OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2010
Last Update Date: 11/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 WATERVIEW PL
NEW HOPE PA
18938-2257
US

IV. Provider business mailing address

505 WATERVIEW PL
NEW HOPE PA
18938-2257
US

V. Phone/Fax

Practice location:
  • Phone: 215-862-0707
  • Fax: 215-862-6655
Mailing address:
  • Phone: 215-862-0707
  • Fax: 215-862-6655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberOC000561L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: