Provider Demographics
NPI:1730410382
Name:WEESNER, HEATHER ANNE
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:ANNE
Last Name:WEESNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 CHARTER DR STE 205
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3687
Mailing Address - Country:US
Mailing Address - Phone:443-546-1590
Mailing Address - Fax:443-546-1576
Practice Address - Street 1:2200 KERNAN DR
Practice Address - Street 2:
Practice Address - City:GWYNN OAK
Practice Address - State:MD
Practice Address - Zip Code:21207-6665
Practice Address - Country:US
Practice Address - Phone:410-448-6323
Practice Address - Fax:410-448-6338
Is Sole Proprietor?:No
Enumeration Date:2010-01-21
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05379225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist