Provider Demographics
NPI:1598210684
Name:HEATON, KARIN M
Entity Type:Individual
Prefix:
First Name:KARIN
Middle Name:M
Last Name:HEATON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KARIN
Other - Middle Name:M
Other - Last Name:HEATON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:307 S STONE CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541-6292
Mailing Address - Country:US
Mailing Address - Phone:850-499-0654
Mailing Address - Fax:
Practice Address - Street 1:807 W LONGHORN RD
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-4263
Practice Address - Country:US
Practice Address - Phone:928-474-1120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6213225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist