Provider Demographics
NPI:1619558632
Name:HOUSTON, HEATHER (OTRL)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RO BEAUMONT DEPART OF REHAB SERVICES
Mailing Address - Street 2:3601 W 13 MILE RD
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-6712
Mailing Address - Country:US
Mailing Address - Phone:248-898-0190
Mailing Address - Fax:
Practice Address - Street 1:RO BEAUMONT DEPT OF REHAB SERVICES
Practice Address - Street 2:3601 W 13 MILE RD
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6712
Practice Address - Country:US
Practice Address - Phone:248-898-0190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201011081225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist