Provider Demographics
NPI:1447462650
Name:WIGHT, HEIDI ELAINE (OTRL)
Entity type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:ELAINE
Last Name:WIGHT
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 RIVER OAKS DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-4590
Mailing Address - Country:US
Mailing Address - Phone:912-312-3962
Mailing Address - Fax:
Practice Address - Street 1:1401 RIVER OAKS DR
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-4590
Practice Address - Country:US
Practice Address - Phone:912-312-3962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2012-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6978225XP0200X
GAOT005445225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics