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Organization
HEATON PEDIATRIC THERAPY INC.
Active
Organization
HEATON PEDIATRIC THERAPY INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRAVIS HEATON (PRESIDENT)
(864) 399-2674
Entity
Organization
Contact information
Practice address
204 SHADY PINES CT, FOUNTAIN INN, SC 29644-9785
(864) 399-2674
Mailing address
PO BOX 1312, FOUNTAIN INN, SC 29644-1054
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
3187
SC
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
Primary
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
09/16/2015
Last updated
09/25/2016
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