Provider Demographics
NPI:1306038146
Name:WEISBROD, SANDRA K (OTR)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:K
Last Name:WEISBROD
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 1:2276 E SEMINOLE DR
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-1974
Mailing Address - Country:US
Mailing Address - Phone:812-886-8931
Mailing Address - Fax:
Practice Address - Street 1:2276 E SEMINOLE DR
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-1974
Practice Address - Country:US
Practice Address - Phone:812-886-8931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31003149A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist