Provider Demographics
NPI:1225235849
Name:WEAVER, KAREN RENEE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:RENEE
Last Name:WEAVER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6784 OLD ZOARVILLE RD NE
Mailing Address - Street 2:
Mailing Address - City:ZOARVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44656-8718
Mailing Address - Country:US
Mailing Address - Phone:330-859-2620
Mailing Address - Fax:
Practice Address - Street 1:2714 13TH ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-3121
Practice Address - Country:US
Practice Address - Phone:330-456-2842
Practice Address - Fax:330-456-5343
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2472224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant