MEDICARE: HANNAH WEISE

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	225X00000X	Occupational Therapist	OT200001251	NC
2	106S00000X	Behavior Technician	RBT-17-36373	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RBT-17-36373	OTHER	KS	REGISTERED BEHVAIOR TECHNICIAN

General Provider Information

NPI Number	:	1285156414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH WEISE

Provider Business Mailing Address
First Line	:	100 W FREMONT ST UNIT 101
Second Line	:
City	:	BURGAW
State	:	NC
Zip	:	28425-5543
Country	:	US
Telephone Number	:	910-679-8385
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 W FREMONT ST UNIT 101
Second Line	:
City	:	BURGAW
State	:	NC
Zip	:	28425-5543
Country	:	US
Telephone Number	:	910-679-8385
Fax Number	:

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

Provider Enumeration Date	:	07/10/2017
Last Update Date	:	02/04/2026

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Directions to “ HANNAH WEISE ” Practice Location

Language	Start Address	Practice Location

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