Provider Demographics
NPI:1629146253
Name:RUDD, HEATHER CARNAHAN (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:CARNAHAN
Last Name:RUDD
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 1:4840 ROSE CREEK DRIVE
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-1831
Mailing Address - Country:US
Mailing Address - Phone:678-947-0146
Mailing Address - Fax:678-947-0147
Practice Address - Street 1:4840 ROSE CREEK DR
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-1831
Practice Address - Country:US
Practice Address - Phone:678-947-0146
Practice Address - Fax:678-947-0147
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT003109225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist