Provider Demographics
NPI:1043605553
Name:WEBER, ABBY (COTA)
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:
Last Name:WEBER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10584 DUNN RD
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46561-9703
Mailing Address - Country:US
Mailing Address - Phone:260-479-7070
Mailing Address - Fax:
Practice Address - Street 1:430 E CLEVELAND RD
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-5624
Practice Address - Country:US
Practice Address - Phone:574-271-3305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-01
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32001722A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN32001722AOtherOCCUPATIONAL THERAPY ASSISTANT