Provider Demographics
NPI:1578216784
Name:DORAIS, HEATHER LEANN (OTRL)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LEANN
Last Name:DORAIS
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:LEANN
Other - Last Name:NEW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTRL
Mailing Address - Street 1:2783 AU GRES RIVER DR
Mailing Address - Street 2:
Mailing Address - City:FOWLERVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48836-9089
Mailing Address - Country:US
Mailing Address - Phone:810-923-3534
Mailing Address - Fax:
Practice Address - Street 1:620 BYRON RD
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-1002
Practice Address - Country:US
Practice Address - Phone:517-545-6333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201009997225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist