Provider Demographics
NPI:1770944886
Name:FORREST, HEATHER (LPTA, OTR/L)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:FORREST
Suffix:
Gender:F
Credentials:LPTA, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 OLD BRICKYARD RD
Mailing Address - Street 2:
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-8971
Mailing Address - Country:US
Mailing Address - Phone:336-667-3986
Mailing Address - Fax:
Practice Address - Street 1:204 OLD BRICKYARD RD
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-8971
Practice Address - Country:US
Practice Address - Phone:336-667-3986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-16
Last Update Date:2023-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA3464225200000X
NC8609225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant