Healthcare Provider Details

I. General information

NPI: 1386564516
Provider Name (Legal Business Name): HEATHER TORRES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CARSON ROAD
ROLAND OK
74954
US

IV. Provider business mailing address

579 WADDLE ST
POTEAU OK
74953-5416
US

V. Phone/Fax

Practice location:
  • Phone: 479-410-7495
  • Fax: 479-777-9907
Mailing address:
  • Phone: 479-410-7495
  • Fax: 479-777-9907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-548412
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: