Individual
JASON ALAN WEIGOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
333 QUAKER AVE APT D, PHILADELPHIA, NY 13673-3199
(610) 217-5359
Mailing address
333 QUAKER AVE APT D, PHILADELPHIA, NY 13673-3199
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
007956-1
NY
Other
Enumeration date
10/03/2011
Last updated
10/03/2011
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