Provider Demographics
NPI:1043307515
Name:JUAN, HEATHER GRACE (OTR/L)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:GRACE
Last Name:JUAN
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:PO BOX 698
Mailing Address - Street 2:
Mailing Address - City:EATONVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98328-0698
Mailing Address - Country:US
Mailing Address - Phone:360-879-1800
Mailing Address - Fax:
Practice Address - Street 1:200 LYNCH STREET W.
Practice Address - Street 2:
Practice Address - City:EATONVILLE
Practice Address - State:WA
Practice Address - Zip Code:98328-0698
Practice Address - Country:US
Practice Address - Phone:360-879-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00004317225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist