Provider Demographics
NPI:1740007566
Name:WEATHERS, TYLER KALEIGH (OTD)
Entity type:Individual
Prefix:MS
First Name:TYLER
Middle Name:KALEIGH
Last Name:WEATHERS
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 SIDNEY BAKER ST S STE 103
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-5980
Mailing Address - Country:US
Mailing Address - Phone:830-896-3130
Mailing Address - Fax:830-896-3132
Practice Address - Street 1:448 SIDNEY BAKER ST S STE 103
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-5980
Practice Address - Country:US
Practice Address - Phone:830-896-3130
Practice Address - Fax:830-896-3132
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX124649225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist