Healthcare Provider Details

I. General information

NPI: 1649495425
Provider Name (Legal Business Name): TERRI ANN WEAVER OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 W 78TH ST
EDINA MN
55439-2516
US

IV. Provider business mailing address

8262 RHODE ISLAND AVE S
BLOOMINGTON MN
55438-1149
US

V. Phone/Fax

Practice location:
  • Phone: 952-914-8073
  • Fax:
Mailing address:
  • Phone: 952-941-6354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number101301
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: