Provider Demographics
NPI:1396092441
Name:WEINER, SHARI (OTR)
Entity type:Individual
Prefix:
First Name:SHARI
Middle Name:
Last Name:WEINER
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 1:14 FOREST ST
Mailing Address - Street 2:UNIT 101
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3554
Mailing Address - Country:US
Mailing Address - Phone:201-704-2819
Mailing Address - Fax:
Practice Address - Street 1:1700 ROUTE 3
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3928
Practice Address - Country:US
Practice Address - Phone:862-591-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR002473225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist