Individual
AMBER RAE WEAVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
1901 N HWY 360 # 410, GRAND PRAIRIE, TX 75050-1412
(817) 652-2924
Mailing address
1202 RED BIRD LN, GRANBURY, TX 76048-2503
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
214865
TX
Other
Enumeration date
02/13/2018
Last updated
11/03/2021
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