Provider Demographics
NPI:1396446530
Name:WEAKLEY, EMILY ROSE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:ROSE
Last Name:WEAKLEY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 FARRIS PARKS BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-7650
Mailing Address - Country:US
Mailing Address - Phone:859-353-3666
Mailing Address - Fax:859-448-7077
Practice Address - Street 1:400 FARRIS PARKS BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-7650
Practice Address - Country:US
Practice Address - Phone:859-353-3666
Practice Address - Fax:859-448-7077
Is Sole Proprietor?:No
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY162831225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist