Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 2365 | NH |
NPI | 1003268004 |
---|---|
Provider Name | Bethany Heidemann |
First Address | Manchester, NH 03109-5948 |
Second Address | Bedford, NH 03110 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2016 |
Last Update Date | 01/07/2016 |