Provider Demographics
NPI:1275953663
Name:PAGE, HEATHER BROOKE (OTR/L)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:BROOKE
Last Name:PAGE
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 1:137 FANTAIL CT
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-9250
Mailing Address - Country:US
Mailing Address - Phone:915-781-6521
Mailing Address - Fax:
Practice Address - Street 1:137 FANTAIL CT
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-9250
Practice Address - Country:US
Practice Address - Phone:915-781-6521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT005680225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics