MEDICARE: WEAVER CONSULTATION PARTNERS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XM0800X	Mental Health Occupational Therapist

General Provider Information

NPI Number	:	1770133217
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEAVER CONSULTATION PARTNERS, LLC

Provider Business Mailing Address
First Line	:	61 OLD TAVERN CIR
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24501-7753
Country	:	US
Telephone Number	:	434-610-1081
Fax Number	:

Provider Business Practice Location Address
First Line	:	1890 NORTHWEST BLVD STE 140
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43212-1637
Country	:	US
Telephone Number	:	614-515-6291
Fax Number	:	617-454-4960

Authorized Official
Title or Position	:	OWNER
Name	:	DAGEN WEAVER
Credential	:
Telephone Number	:	434-610-1081

Provider Enumeration Date	:	09/17/2019
Last Update Date	:	09/17/2019

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