Provider Demographics
NPI:1801350541
Name:HEFLIN, KELLY (COTA/L)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:HEFLIN
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 1:322 MARDIS POINT RD
Mailing Address - Street 2:
Mailing Address - City:JOPPA
Mailing Address - State:AL
Mailing Address - Zip Code:35087-6264
Mailing Address - Country:US
Mailing Address - Phone:256-640-1602
Mailing Address - Fax:
Practice Address - Street 1:12000 TURNMEYER DR SE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35803-3358
Practice Address - Country:US
Practice Address - Phone:256-883-0165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4343224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant