Provider Demographics
NPI:1053867978
Name:WEIBEL, MYLA
Entity Type:Individual
Prefix:
First Name:MYLA
Middle Name:
Last Name:WEIBEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2170 CAROL VIEW DRIVE
Mailing Address - Street 2:APT A303
Mailing Address - City:CARDIFF
Mailing Address - State:CA
Mailing Address - Zip Code:92007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2170 CAROL VIEW DR
Practice Address - Street 2:APT A303
Practice Address - City:CARDIFF
Practice Address - State:CA
Practice Address - Zip Code:92007-1846
Practice Address - Country:US
Practice Address - Phone:717-951-8771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOTA3103224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant