MEDICARE: MARY JANE WEISS

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	225XP0200X	Pediatric Occupational Therapist	101219	TX

General Provider Information

NPI Number	:	1225454127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY JANE WEISS

Provider Business Mailing Address
First Line	:	11933 MISSION TRACE ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-2123
Country	:	US
Telephone Number	:	210-690-8650
Fax Number	:

Provider Business Practice Location Address
First Line	:	11933 MISSION TRACE ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-2123
Country	:	US
Telephone Number	:	210-690-8650
Fax Number	:

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

Provider Enumeration Date	:	03/15/2014
Last Update Date	:	03/15/2014

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Directions to “ MARY JANE WEISS ” Practice Location

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