Healthcare Provider Details

I. General information

NPI: 1952482473
Provider Name (Legal Business Name): HEATHER ANN MAHNKEN MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER ANN REINART MS, OTR/L

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 JACKSON ST NE
FT. WALTON BEACH FL
32548
US

IV. Provider business mailing address

768 ST. VINCENT CV
NICEVILLE FL
32578
US

V. Phone/Fax

Practice location:
  • Phone: 850-862-7227
  • Fax:
Mailing address:
  • Phone: 850-279-6431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5322
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number12365
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: