Provider Demographics
NPI:1750868899
Name:SQUANDA, HEATHER MARIE (MSOT, OTR/L)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:SQUANDA
Suffix:
Gender:F
Credentials:MSOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 MARKEL RD
Mailing Address - Street 2:
Mailing Address - City:MUNGER
Mailing Address - State:MI
Mailing Address - Zip Code:48747-9763
Mailing Address - Country:US
Mailing Address - Phone:989-737-1577
Mailing Address - Fax:
Practice Address - Street 1:600 E CARPENTER ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-5417
Practice Address - Country:US
Practice Address - Phone:989-923-3681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-22
Last Update Date:2018-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201007687225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist