Provider Demographics
NPI:1578761383
Name:NAGEOTTE, HEATHER SKIDMORE (PTA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:SKIDMORE
Last Name:NAGEOTTE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2123 TONDA LN
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-3784
Mailing Address - Country:US
Mailing Address - Phone:614-648-0428
Mailing Address - Fax:
Practice Address - Street 1:3710 OLENTANGY RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3450
Practice Address - Country:US
Practice Address - Phone:614-457-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH04582225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant