Provider Demographics
NPI:1164731204
Name:PUGH, HEATHER KENNELL (MA, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:KENNELL
Last Name:PUGH
Suffix:
Gender:F
Credentials:MA, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2975 JADWYN RD
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22664-2905
Mailing Address - Country:US
Mailing Address - Phone:540-247-9896
Mailing Address - Fax:
Practice Address - Street 1:2975 JADWYN RD
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:VA
Practice Address - Zip Code:22664-2905
Practice Address - Country:US
Practice Address - Phone:540-247-9896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-06
Last Update Date:2022-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119003366225XP0200X, 225X00000X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist