Provider Demographics
NPI:1922110550
Name:O'BRIEN, HEATHER ELIZABETH (OTR)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:ELIZABETH
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:O'BRIEN
Other - Last Name:TABLIZO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:1248 AUSTIN HWY STE 210
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-4867
Mailing Address - Country:US
Mailing Address - Phone:210-646-8008
Mailing Address - Fax:210-646-8242
Practice Address - Street 1:1248 AUSTIN HWY STE 210
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-4867
Practice Address - Country:US
Practice Address - Phone:219-646-8008
Practice Address - Fax:210-646-8242
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107536225XP0200X, 225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T0947OtherBCBS
TX75285003678239A007OtherTRICARE