Provider Demographics
NPI:1245330877
Name:WEISS, LORA ELLEN (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:LORA
Middle Name:ELLEN
Last Name:WEISS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:977 INNSWOOD CT
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-2807
Mailing Address - Country:US
Mailing Address - Phone:407-389-0555
Mailing Address - Fax:407-682-1141
Practice Address - Street 1:977 INNSWOOD CT
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-2807
Practice Address - Country:US
Practice Address - Phone:407-389-0555
Practice Address - Fax:407-682-1141
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT979225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist