Provider Demographics
NPI:1316070675
Name:BRASWELL, HEATHER JO (OTL)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:JO
Last Name:BRASWELL
Suffix:
Gender:F
Credentials:OTL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 FAWN HILL RD
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-8223
Mailing Address - Country:US
Mailing Address - Phone:443-496-2878
Mailing Address - Fax:717-632-6362
Practice Address - Street 1:4730 ATRIUM CT
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-3556
Practice Address - Country:US
Practice Address - Phone:410-363-0330
Practice Address - Fax:410-363-8795
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03182225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist