Provider Demographics
NPI:1063080158
Name:JORDAN, HEATHER (COTA/L)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:RINEHART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COTA/L
Mailing Address - Street 1:2645 STONEY POINT RD
Mailing Address - Street 2:
Mailing Address - City:MALTA
Mailing Address - State:OH
Mailing Address - Zip Code:43758-9766
Mailing Address - Country:US
Mailing Address - Phone:740-343-3334
Mailing Address - Fax:
Practice Address - Street 1:51 E 4TH ST
Practice Address - Street 2:
Practice Address - City:THE PLAINS
Practice Address - State:OH
Practice Address - Zip Code:45780-1346
Practice Address - Country:US
Practice Address - Phone:740-797-4561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03657224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant