Provider Demographics
NPI:1376167726
Name:ORR, HEATHER K
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:K
Last Name:ORR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARLOW
Mailing Address - State:OK
Mailing Address - Zip Code:73055-2439
Mailing Address - Country:US
Mailing Address - Phone:580-721-7100
Mailing Address - Fax:833-210-5732
Practice Address - Street 1:231 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MARLOW
Practice Address - State:OK
Practice Address - Zip Code:73055-2439
Practice Address - Country:US
Practice Address - Phone:580-721-7100
Practice Address - Fax:833-210-5732
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-02
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1376225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant