Provider Demographics
NPI:1669933537
Name:WEAVER, KYLIE JAYDE (MD)
Entity type:Individual
Prefix:MRS
First Name:KYLIE
Middle Name:JAYDE
Last Name:WEAVER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-2150
Mailing Address - Country:US
Mailing Address - Phone:610-463-4722
Mailing Address - Fax:
Practice Address - Street 1:1801 FOLKEMER CIR
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17404-1771
Practice Address - Country:US
Practice Address - Phone:717-650-1140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC015754225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology