Provider Demographics
NPI:1386124972
Name:WEAVER, MARTHA ADDISON
Entity type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:ADDISON
Last Name:WEAVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 MATTHEWS MINT HILL RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-2889
Mailing Address - Country:US
Mailing Address - Phone:704-727-8680
Mailing Address - Fax:980-422-0277
Practice Address - Street 1:325 MATTHEWS MINT HILL RD STE 101
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-2889
Practice Address - Country:US
Practice Address - Phone:704-727-8680
Practice Address - Fax:980-422-0277
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4952235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist