Provider Demographics
NPI:1730239823
Name:DITARANTO, HEATHER LEIGH (OTRL)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:LEIGH
Last Name:DITARANTO
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:17818 MISSION OAK DR
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-4803
Mailing Address - Country:US
Mailing Address - Phone:813-841-7484
Mailing Address - Fax:813-571-5511
Practice Address - Street 1:11009 THERESA ARBOR DR
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-3166
Practice Address - Country:US
Practice Address - Phone:813-841-7484
Practice Address - Fax:813-570-6693
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT9497225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL354933OtherWELLCARE
FL27529OtherBCBS
FL570616636OtherTRICARE
FL11194801OtherCITRUS HMO
FL885848900Medicaid