Provider Demographics
NPI:1982155099
Name:DORGAN, HEATHER (OTR/L)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:DORGAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 LOW ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-3540
Mailing Address - Country:US
Mailing Address - Phone:978-462-7373
Mailing Address - Fax:
Practice Address - Street 1:113 LOW ST
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-3540
Practice Address - Country:US
Practice Address - Phone:978-462-7373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1866225X00000X
MEOT2628225X00000X
NH0644225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist