MEDICARE: MS. JANET D WEISBERG MS OTR/L HPCS

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	174400000X	Specialist	102362	MN

General Provider Information

NPI Number	:	1487687802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JANET D WEISBERG MS OTR/L HPCS

Provider Business Mailing Address
First Line	:	5120 COLONIAL DR
Second Line	:
City	:	GOLDEN VALLEY
State	:	MN
Zip	:	55416-1107
Country	:	US
Telephone Number	:	763-595-7112
Fax Number	:

Provider Business Practice Location Address
First Line	:	6824 COUNTY ROAD 6
Second Line	:
City	:	INDEPENDENCE
State	:	MN
Zip	:	55359-9509
Country	:	US
Telephone Number	:	763-595-7112
Fax Number	:

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

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	04/10/2014

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