Provider Demographics
NPI:1053876433
Name:WEAVER, KAREN HILJA (OT/L)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:HILJA
Last Name:WEAVER
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 ONEIDA ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55804-1538
Mailing Address - Country:US
Mailing Address - Phone:218-730-3201
Mailing Address - Fax:
Practice Address - Street 1:16618 W 159TH ST STE 402
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-8011
Practice Address - Country:US
Practice Address - Phone:815-838-0529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-09
Last Update Date:2019-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN104726225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist