Provider Demographics
NPI:1669249280
Name:WEAVER, CYNDI DIANNE (COTA)
Entity type:Individual
Prefix:MS
First Name:CYNDI
Middle Name:DIANNE
Last Name:WEAVER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MR
Other - First Name:CYNDI
Other - Middle Name:DIANNE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:304 S CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-3611
Mailing Address - Country:US
Mailing Address - Phone:913-982-7989
Mailing Address - Fax:
Practice Address - Street 1:8951 E 60TH ST
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64133-3710
Practice Address - Country:US
Practice Address - Phone:816-353-8585
Practice Address - Fax:816-353-5808
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017043014224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant