Provider Demographics
NPI:1750436168
Name:SPANN, HEATHER WEART (OTRL)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:WEART
Last Name:SPANN
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:ANNE
Other - Last Name:WEART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:559 WHITE CHAPEL CIR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-4349
Mailing Address - Country:US
Mailing Address - Phone:843-469-3929
Mailing Address - Fax:843-277-6443
Practice Address - Street 1:559 WHITE CHAPEL CIR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-4349
Practice Address - Country:US
Practice Address - Phone:843-469-3929
Practice Address - Fax:843-277-6443
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2466225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH1109Medicaid