Provider Demographics
NPI:1255885828
Name:HEAZLIT, JEANETTE (COTA/L)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:HEAZLIT
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 1:8337 FRIENDSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44273-9117
Mailing Address - Country:US
Mailing Address - Phone:330-302-0103
Mailing Address - Fax:
Practice Address - Street 1:8337 FRIENDSVILLE RD
Practice Address - Street 2:
Practice Address - City:SEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44273-9117
Practice Address - Country:US
Practice Address - Phone:330-302-0103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA.04938224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant