Provider Demographics
NPI:1104006220
Name:CELKIS, HEATHER DOREEN-SCOTT (BS)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:DOREEN-SCOTT
Last Name:CELKIS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 LEANDER RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-8835
Mailing Address - Country:US
Mailing Address - Phone:512-930-5439
Mailing Address - Fax:512-930-5431
Practice Address - Street 1:1910 LEANDER RD
Practice Address - Street 2:SUITE 102
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-8835
Practice Address - Country:US
Practice Address - Phone:512-930-5439
Practice Address - Fax:512-930-5431
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112447225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist