Provider Demographics
NPI:1083194179
Name:WEGER, MARDEL HOLLIE (COTA)
Entity Type:Individual
Prefix:
First Name:MARDEL
Middle Name:HOLLIE
Last Name:WEGER
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 1:3628 FARM ROAD 196 N
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75462-1564
Mailing Address - Country:US
Mailing Address - Phone:903-272-6818
Mailing Address - Fax:
Practice Address - Street 1:1303 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HONEY GROVE
Practice Address - State:TX
Practice Address - Zip Code:75446-1268
Practice Address - Country:US
Practice Address - Phone:903-378-2293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant