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General NPI Number Information
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NPI Number | 1922715937
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Entity Type | Individual
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Provider Name | SOPHIA MARIE WEIDLING MOT, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 10/31/2022
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Last Update Date | 10/31/2022
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Provider Practice Location Address
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Address Line | 2525 E ROOSEVELT ST
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City | PHOENIX
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State | AZ
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Zip | 85008-4948
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Country | US
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Telephone | 602-344-5318
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Fax |
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Provider Business Mailing Address
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Address Line | 400 N CORONADO ST APT 3051
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City | CHANDLER
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State | AZ
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Zip | 85224-3208
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Country | US
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Telephone | 651-274-4017
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OTH-008665
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License Number State | AZ
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