Individual
MAMIE WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4560 SE INTERNATIONAL WAY, STE 100, MILWAUKIE, OR 97222-4628
(971) 206-5140
Mailing address
417 8TH ST NW, MOUNT VERNON, IA 52314-1145
(319) 721-5945
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
000996
IA
Other
Enumeration date
08/22/2016
Last updated
08/22/2016
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