Provider Demographics
NPI:1093988149
Name:WEISS, PAULA MARIE (OTR)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:MARIE
Last Name:WEISS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W14786 STATE ROAD 16
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN DELLS
Mailing Address - State:WI
Mailing Address - Zip Code:53965-9425
Mailing Address - Country:US
Mailing Address - Phone:608-254-4065
Mailing Address - Fax:
Practice Address - Street 1:W14786 STATE ROAD 16
Practice Address - Street 2:
Practice Address - City:WISCONSIN DELLS
Practice Address - State:WI
Practice Address - Zip Code:53965-9425
Practice Address - Country:US
Practice Address - Phone:608-254-4065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3059-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist