Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | OC005748L | PA |
NPI | 1265084982 |
---|---|
Provider Name | Dwight Heller |
First Address | Muncy, PA 17756-8828 |
Second Address | Muncy, PA 17756-8828 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2019 |
Last Update Date | 12/07/2019 |