Basic Information
| Provider Information | |||||||||
| NPI: | 1053565838 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEBER | ||||||||
| FirstName: | ADAM | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | N1699 MEDINA DR | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 549428506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9202420702 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1550 MIDWAY PL | ||||||||
| Address2: | |||||||||
| City: | MENASHA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 549521165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9207382000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2008 | ||||||||
| LastUpdateDate: | 08/05/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.