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General NPI Number Information
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NPI Number | 1497432637
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Entity Type | Individual
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Provider Name | JENNIFER LYSAA WEISS
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Gender | Female
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Dates
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Enumeration Date | 06/29/2023
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Last Update Date | 06/29/2023
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Provider Practice Location Address
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Address Line | 9291 GLADES RD STE 201
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City | BOCA RATON
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State | FL
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Zip | 33434-3959
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Country | US
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Telephone | 561-470-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 21234 CLUBSIDE DR APT C
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City | BOCA RATON
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State | FL
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Zip | 33434-4757
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 17884
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License Number State | FL
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