Provider Demographics
NPI:1407179393
Name:WEISINGER, ELIZABETH ROSS
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ROSS
Last Name:WEISINGER
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 1:60 LOUIS PRIMA DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-5903
Mailing Address - Country:US
Mailing Address - Phone:985-809-8035
Mailing Address - Fax:985-809-0223
Practice Address - Street 1:60 LOUIS PRIMA DR
Practice Address - Street 2:SUITE A
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-5903
Practice Address - Country:US
Practice Address - Phone:985-809-8035
Practice Address - Fax:985-809-0223
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-05
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ10577225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist