Provider Demographics
NPI:1932589066
Name:VAILLANCOURT, HEATHER MELISSA (OTR)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:MELISSA
Last Name:VAILLANCOURT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12915 MASON TERRACE LN
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-7579
Mailing Address - Country:US
Mailing Address - Phone:713-459-5783
Mailing Address - Fax:
Practice Address - Street 1:12915 MASON TERRACE LN
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-7579
Practice Address - Country:US
Practice Address - Phone:713-459-5783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115977225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist