Provider Demographics
NPI:1932707213
Name:WEIRE, KRISTIN (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:
Last Name:WEIRE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 WOODHALL DR
Mailing Address - Street 2:
Mailing Address - City:WILLOW STREET
Mailing Address - State:PA
Mailing Address - Zip Code:17584-9425
Mailing Address - Country:US
Mailing Address - Phone:717-475-9544
Mailing Address - Fax:
Practice Address - Street 1:722 FURNACE HILLS PIKE
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-7954
Practice Address - Country:US
Practice Address - Phone:717-626-2071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP006326224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty