Provider Demographics
NPI:1639498785
Name:WEAVER, JENNIFER WIERZBIC (MOT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:WIERZBIC
Last Name:WEAVER
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 NE 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-4563
Mailing Address - Country:US
Mailing Address - Phone:352-872-3614
Mailing Address - Fax:
Practice Address - Street 1:5211 SW 91ST TER
Practice Address - Street 2:SUITE B
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-8128
Practice Address - Country:US
Practice Address - Phone:352-505-6363
Practice Address - Fax:352-505-6383
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14173225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist