Provider Demographics
NPI:1275833808
Name:TABOR, HEATHER M (MHS OTR/L)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:M
Last Name:TABOR
Suffix:
Gender:F
Credentials:MHS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2881 MONROE HWY STE 501
Mailing Address - Street 2:
Mailing Address - City:BOGART
Mailing Address - State:GA
Mailing Address - Zip Code:30622-8529
Mailing Address - Country:US
Mailing Address - Phone:770-316-4634
Mailing Address - Fax:
Practice Address - Street 1:2881 MONROE HWY STE 501
Practice Address - Street 2:
Practice Address - City:BOGART
Practice Address - State:GA
Practice Address - Zip Code:30622-8529
Practice Address - Country:US
Practice Address - Phone:770-316-4634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-29
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006532225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist