Healthcare Provider Details

I. General information

NPI: 1598167199
Provider Name (Legal Business Name): MELISSA WEAVER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2014
Last Update Date: 09/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 N DIERS AVE SUITE 300
GRAND ISLAND NE
68803-4984
US

IV. Provider business mailing address

PO BOX 5285
GRAND ISLAND NE
68802-5285
US

V. Phone/Fax

Practice location:
  • Phone: 308-382-0344
  • Fax: 308-382-3241
Mailing address:
  • Phone: 308-382-0344
  • Fax: 308-382-3241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number471
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: