Provider Demographics
NPI:1831666023
Name:TATE, HEATHER JEAN (COTA/L)
Entity Type:Individual
Prefix:MISS
First Name:HEATHER
Middle Name:JEAN
Last Name:TATE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29133 N SHANNON DR
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VLY
Mailing Address - State:AZ
Mailing Address - Zip Code:85143-3968
Mailing Address - Country:US
Mailing Address - Phone:602-723-3016
Mailing Address - Fax:
Practice Address - Street 1:29133 N SHANNON DR
Practice Address - Street 2:
Practice Address - City:SAN TAN VLY
Practice Address - State:AZ
Practice Address - Zip Code:85143-3968
Practice Address - Country:US
Practice Address - Phone:602-723-3016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-26
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTA-046667224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant