Provider Demographics
NPI:1821265505
Name:WEISS, JEREMEY LEONARD (OT)
Entity Type:Individual
Prefix:MR
First Name:JEREMEY
Middle Name:LEONARD
Last Name:WEISS
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 BELMAWR PL
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-1561
Mailing Address - Country:US
Mailing Address - Phone:443-224-7403
Mailing Address - Fax:
Practice Address - Street 1:555 BELMAWR PL
Practice Address - Street 2:
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-1561
Practice Address - Country:US
Practice Address - Phone:443-224-7403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD0162268146N00000X
MDN/A247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic