Provider Demographics
NPI:1487190534
Name:WEAVER, KATIE COLLEEN (OTR/L)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:COLLEEN
Last Name:WEAVER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:COLLEEN
Other - Last Name:HARVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:415 36TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-1005
Mailing Address - Country:US
Mailing Address - Phone:304-917-3660
Mailing Address - Fax:304-917-3674
Practice Address - Street 1:2010 GARFIELD AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-2527
Practice Address - Country:US
Practice Address - Phone:304-917-3649
Practice Address - Fax:304-917-3651
Is Sole Proprietor?:No
Enumeration Date:2017-01-13
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1500225X00000X
OHOT.008182225X00000X
NC10692225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist