Provider Demographics
NPI:1992178651
Name:MENTZER, HEATHER DANIELLE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:DANIELLE
Last Name:MENTZER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:DANIELLE
Other - Last Name:MINNICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:314 BARNETT AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:PA
Mailing Address - Zip Code:17268-1810
Mailing Address - Country:US
Mailing Address - Phone:717-387-0582
Mailing Address - Fax:
Practice Address - Street 1:314 BARNETT AVE
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:PA
Practice Address - Zip Code:17268-1810
Practice Address - Country:US
Practice Address - Phone:717-387-0582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC014045225X00000X
MD04777225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist