Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 5714 | TN |
NPI | 1447923834 |
---|---|
Provider Name | Dr. Kaylin Elizabeth Miley Weaver |
First Address | Clarksville, TN 37043-4105 |
Second Address | Clarksville, TN 37043-4105 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2021 |
Last Update Date | 30/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5714 | TENNESSEE STATE BOARD OF OCCUPATIONAL THERAPY (01) | TN |