Provider Demographics
NPI:1568055754
Name:TRUESDALE, HEATHER BOATWRIGHT (MS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:BOATWRIGHT
Last Name:TRUESDALE
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:LYNN
Other - Last Name:BOATWRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:3 BOWIE DRIVE
Mailing Address - Street 2:
Mailing Address - City:LUGOFF
Mailing Address - State:SC
Mailing Address - Zip Code:29078
Mailing Address - Country:US
Mailing Address - Phone:803-420-2254
Mailing Address - Fax:
Practice Address - Street 1:3620 COVENANT RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-4216
Practice Address - Country:US
Practice Address - Phone:803-787-3033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-18
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6033225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty