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General NPI Number Information
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NPI Number | 1609424282
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Entity Type | Individual
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Provider Name | HEATHER LYNN OT
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Gender | Female
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Dates
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Enumeration Date | 08/28/2019
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Last Update Date | 11/23/2020
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Provider Practice Location Address
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Address Line | 7452 FULTON DR NW STE A
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City | MASSILLON
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State | OH
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Zip | 44646-9393
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Country | US
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Telephone | 330-880-4111
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Fax | 330-833-1817
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Provider Business Mailing Address
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Address Line | 1193 NORTON AVE STE A
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City | NORTON
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State | OH
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Zip | 44203-9526
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Country | US
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Telephone | 330-825-1152
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Fax | 330-854-0829
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT010722
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License Number State | OH
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