Provider Demographics
NPI:1801624044
Name:WEAVER, NATALIE S (MT-BC)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:S
Last Name:WEAVER
Suffix:
Gender:X
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 N MCKINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80521-2320
Mailing Address - Country:US
Mailing Address - Phone:970-227-8160
Mailing Address - Fax:
Practice Address - Street 1:116 N MCKINLEY AVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80521-2320
Practice Address - Country:US
Practice Address - Phone:970-227-8160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
18428225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist