Provider Demographics
NPI:1437496320
Name:WEBER, WENDY (OTA)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:
Last Name:WEBER
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6868BW WEST TILLEN RD
Mailing Address - Street 2:PO BOX 374
Mailing Address - City:BOSTON
Mailing Address - State:NY
Mailing Address - Zip Code:14025
Mailing Address - Country:US
Mailing Address - Phone:716-941-6530
Mailing Address - Fax:
Practice Address - Street 1:6868BW WEST TILLEN RD
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:NY
Practice Address - Zip Code:14025
Practice Address - Country:US
Practice Address - Phone:716-941-6530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0035931224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant