Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT007018 | OH |
NPI | 1003570896 |
---|---|
Provider Name | Brady D Heistand |
First Address | North Canton, OH 44720-6301 |
Second Address | Pickerington, OH 43147-2100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2021 |
Last Update Date | 27/10/2021 |