Provider Demographics
NPI:1700257250
Name:WEAVER, ALEXIS (OT)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:WEAVER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16785 371 HWY
Mailing Address - Street 2:
Mailing Address - City:PLATTE CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64079-9779
Mailing Address - Country:US
Mailing Address - Phone:816-499-2620
Mailing Address - Fax:
Practice Address - Street 1:20551 E TRINITY PL
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-9501
Practice Address - Country:US
Practice Address - Phone:816-988-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-09
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015028981224Z00000X
MO2020037745225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU4372328005OtherCIGNA