Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 006873-1 | NY |
NPI | 1043459225 |
---|---|
Provider Name | Mrs. Lori Beth Weiss |
First Address | Fairport, NY 14450-8958 |
Second Address | Fairport, NY 14450-8958 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2009 |
Last Update Date | 12/02/2009 |