Provider Demographics
NPI:1831828375
Name:WEIDNER, ELIZABETH NICOLE (MOT)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:NICOLE
Last Name:WEIDNER
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 SAND VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:17086-9603
Mailing Address - Country:US
Mailing Address - Phone:717-364-7220
Mailing Address - Fax:
Practice Address - Street 1:36 ENVISION DR
Practice Address - Street 2:
Practice Address - City:MIFFLINTOWN
Practice Address - State:PA
Practice Address - Zip Code:17059-7724
Practice Address - Country:US
Practice Address - Phone:717-320-5108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist