Provider Demographics
NPI:1801008586
Name:WEBER, AMY M (OTR)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:M
Last Name:WEBER
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:P.O. BOX 340
Mailing Address - Street 2:
Mailing Address - City:COBALT
Mailing Address - State:CT
Mailing Address - Zip Code:06414-0340
Mailing Address - Country:US
Mailing Address - Phone:860-267-0456
Mailing Address - Fax:860-365-0389
Practice Address - Street 1:56 DEPOT HILL ROAD
Practice Address - Street 2:
Practice Address - City:COBALT
Practice Address - State:CT
Practice Address - Zip Code:06414-0340
Practice Address - Country:US
Practice Address - Phone:860-267-0456
Practice Address - Fax:860-365-0389
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002411225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics