Provider Demographics
NPI:1770963837
Name:WEISZ, ADRIENNE LOUISE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:LOUISE
Last Name:WEISZ
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 1:503 CHRISTIAN CIR
Mailing Address - Street 2:
Mailing Address - City:SENOIA
Mailing Address - State:GA
Mailing Address - Zip Code:30276-1574
Mailing Address - Country:US
Mailing Address - Phone:770-755-8398
Mailing Address - Fax:
Practice Address - Street 1:105 GLENDALOUGH CT
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:GA
Practice Address - Zip Code:30290-2948
Practice Address - Country:US
Practice Address - Phone:678-632-6765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004007225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics