Provider Demographics
NPI:1073727566
Name:HIEATT, JACQUELYN (OTR/L)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:HIEATT
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 1:15937 LONG MEADOW WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-5895
Mailing Address - Country:US
Mailing Address - Phone:502-417-7484
Mailing Address - Fax:
Practice Address - Street 1:15937 LONG MEADOW WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-5895
Practice Address - Country:US
Practice Address - Phone:502-417-7484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-R3506225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist