Provider Demographics
NPI:1518104371
Name:TANGUAY, HEATHER (MSOTR/L)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:TANGUAY
Suffix:
Gender:M
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1437 BENT OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-8061
Mailing Address - Country:US
Mailing Address - Phone:386-734-5525
Mailing Address - Fax:
Practice Address - Street 1:1437 BENT OAKS BLVD
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-8061
Practice Address - Country:US
Practice Address - Phone:386-734-5525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT9713225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics