Individual
ANGELA M WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
1245 WASHINGTON AVE, DETROIT LAKES, MN 56501-3905
(218) 846-7013
(218) 846-7015
Mailing address
1245 WASHINGTON AVE, DETROIT LAKES, MN 56501-3905
(218) 846-7013
(218) 846-7015
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
102587
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
56156
—
ND
Enumeration date
01/11/2013
Last updated
04/08/2013
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