Basic Information
| Provider Information | |||||||||
| NPI: | 1730410382 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEESNER | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10700 CHARTER DR STE 205 | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210443687 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4435461590 | ||||||||
| FaxNumber: | 4435461576 | ||||||||
| Practice Location | |||||||||
| Address1: | 2200 KERNAN DR | ||||||||
| Address2: | |||||||||
| City: | GWYNN OAK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212076665 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4104486323 | ||||||||
| FaxNumber: | 4104486338 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/21/2010 | ||||||||
| LastUpdateDate: | 06/14/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 05379 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.