Provider Demographics
NPI:1831941608
Name:HEIDINGER, TERESA A (COTA/L)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:A
Last Name:HEIDINGER
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 1:152 SIMS CREEK LN
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7984
Mailing Address - Country:US
Mailing Address - Phone:954-945-6675
Mailing Address - Fax:
Practice Address - Street 1:152 SIMS CREEK LN
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7984
Practice Address - Country:US
Practice Address - Phone:954-945-6675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA9781224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant