Provider Demographics
NPI:1154929065
Name:DRIVER, HEATHER DAWN (OT/L)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:DAWN
Last Name:DRIVER
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:NEW MADISON
Mailing Address - State:OH
Mailing Address - Zip Code:45346-8801
Mailing Address - Country:US
Mailing Address - Phone:937-423-7705
Mailing Address - Fax:
Practice Address - Street 1:750 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:OH
Practice Address - Zip Code:45331-1312
Practice Address - Country:US
Practice Address - Phone:937-547-7689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00005579225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist