Provider Demographics
NPI:1992196489
Name:WEBER, KIERSTIN SARAH (OT)
Entity Type:Individual
Prefix:MRS
First Name:KIERSTIN
Middle Name:SARAH
Last Name:WEBER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MISS
Other - First Name:KIERSTIN
Other - Middle Name:SARAH
Other - Last Name:VAN SCOTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:20195 CORTEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601-3850
Mailing Address - Country:US
Mailing Address - Phone:352-754-4500
Mailing Address - Fax:352-754-9343
Practice Address - Street 1:20195 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601
Practice Address - Country:US
Practice Address - Phone:352-754-4500
Practice Address - Fax:352-754-9343
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCOT10039225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist