Provider Demographics
NPI:1821718255
Name:WEAVER, KAYLA SEMONE (LMT)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:SEMONE
Last Name:WEAVER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4417 N HOLLAND SYLVANIA RD STE 301-A
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-3518
Mailing Address - Country:US
Mailing Address - Phone:419-475-9355
Mailing Address - Fax:419-841-9537
Practice Address - Street 1:4417 N HOLLAND SYLVANIA RD STE 301-A
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3518
Practice Address - Country:US
Practice Address - Phone:419-475-9355
Practice Address - Fax:419-841-9537
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.024730225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist