Provider Demographics
NPI:1679743116
Name:POWELL, HEATHER C (OTR)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:C
Last Name:POWELL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:7616 CULEBRA RD
Mailing Address - Street 2:SUITE #115
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-1476
Mailing Address - Country:US
Mailing Address - Phone:210-260-6719
Mailing Address - Fax:210-681-7192
Practice Address - Street 1:7616 CULEBRA RD
Practice Address - Street 2:SUITE #115
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-1476
Practice Address - Country:US
Practice Address - Phone:210-260-6719
Practice Address - Fax:210-681-7192
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-11
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110965225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist