Provider Demographics
NPI:1275164857
Name:WEAVER, JENNIFER A (OTR/L)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:WEAVER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 GUERRERO ST APT 102
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-2378
Mailing Address - Country:US
Mailing Address - Phone:918-814-0318
Mailing Address - Fax:
Practice Address - Street 1:248 GUERRERO ST APT 102
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2378
Practice Address - Country:US
Practice Address - Phone:918-814-0318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19691225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist