Provider Demographics
NPI:1851162812
Name:WEAVER, EMILY MARIE (OTD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:MARIE
Last Name:WEAVER
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:DR
Other - First Name:EMILY
Other - Middle Name:MARIE
Other - Last Name:AVILES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTD
Mailing Address - Street 1:4710 TIMBER TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-5399
Mailing Address - Country:US
Mailing Address - Phone:513-423-9496
Mailing Address - Fax:
Practice Address - Street 1:4710 TIMBER TRAIL DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-5399
Practice Address - Country:US
Practice Address - Phone:513-423-9496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT011135225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist