Provider Demographics
NPI:1508168501
Name:WEISBERG, SALLY (OTR)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:WEISBERG
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 1:505 WATERVIEW PL
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:PA
Mailing Address - Zip Code:18938-2257
Mailing Address - Country:US
Mailing Address - Phone:215-862-0707
Mailing Address - Fax:215-862-6655
Practice Address - Street 1:505 WATERVIEW PL
Practice Address - Street 2:
Practice Address - City:NEW HOPE
Practice Address - State:PA
Practice Address - Zip Code:18938-2257
Practice Address - Country:US
Practice Address - Phone:215-862-0707
Practice Address - Fax:215-862-6655
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-23
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC000561L225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation