Provider Demographics
NPI:1154633469
Name:WEIDNER, STACIE LYNN (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:LYNN
Last Name:WEIDNER
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 CRICKLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-8507
Mailing Address - Country:US
Mailing Address - Phone:484-266-0387
Mailing Address - Fax:484-266-0409
Practice Address - Street 1:613 CRICKLEWOOD RD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-8507
Practice Address - Country:US
Practice Address - Phone:484-266-0387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-02
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC010891225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology