Provider Demographics
NPI:1477161024
Name:TRITSAROLIS, HEATHER NICOLE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:NICOLE
Last Name:TRITSAROLIS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 JEFFREY DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-4335
Mailing Address - Country:US
Mailing Address - Phone:540-613-0904
Mailing Address - Fax:
Practice Address - Street 1:4920 WOODMAR DR SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-1651
Practice Address - Country:US
Practice Address - Phone:866-450-4522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131001463224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant