Provider Demographics
NPI:1548742018
Name:HEUERTZ, ANN MARIE (COTA)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:HEUERTZ
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2714 RED BLUFF RAMP RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-7844
Mailing Address - Country:US
Mailing Address - Phone:325-212-1404
Mailing Address - Fax:
Practice Address - Street 1:3745 SUMMER CREST DR
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76901-9782
Practice Address - Country:US
Practice Address - Phone:325-942-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI207165224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty