Provider Demographics
NPI:1114195542
Name:ROSEHEART, SKYLARR NURIA SUSAN (BS OTR/L)
Entity Type:Individual
Prefix:MS
First Name:SKYLARR
Middle Name:NURIA SUSAN
Last Name:ROSEHEART
Suffix:
Gender:F
Credentials:BS OTR/L
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:CAROL
Other - Last Name:REID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS OTR/L
Mailing Address - Street 1:711 SIGNAL MOUNTAIN RD # 306
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-1823
Mailing Address - Country:US
Mailing Address - Phone:423-544-6170
Mailing Address - Fax:
Practice Address - Street 1:195 MATTIE M KELLY BLVD
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-2811
Practice Address - Country:US
Practice Address - Phone:850-654-7474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN395225X00000X
FL12311225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist