Provider Demographics
NPI:1134467194
Name:WEAVER, HAROLD B (OTR)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:B
Last Name:WEAVER
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 WAMPANOAG CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-5746
Mailing Address - Country:US
Mailing Address - Phone:401-486-6398
Mailing Address - Fax:
Practice Address - Street 1:77 WAMPANOAG CIR
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-5746
Practice Address - Country:US
Practice Address - Phone:401-486-6398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-27
Last Update Date:2013-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI00069225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist