Provider Demographics
NPI:1316388713
Name:DEVEREAUX, HEATHER MARIE (OT)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:MARIE
Last Name:DEVEREAUX
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:MARIE
Other - Last Name:KOPULOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:206 PAGE AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2418
Mailing Address - Country:US
Mailing Address - Phone:517-783-6670
Mailing Address - Fax:517-783-5310
Practice Address - Street 1:206 PAGE AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2418
Practice Address - Country:US
Practice Address - Phone:517-783-6670
Practice Address - Fax:517-783-5310
Is Sole Proprietor?:No
Enumeration Date:2013-07-13
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201008363225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist