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NPI Code Detail

MEDICARE: HEATHER LARAEL PETERS

MEDICARE: HEATHER LARAEL PETERS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1356204291
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEATHER LARAEL PETERS
Provider Business Mailing Address
First Line : 315 SPIREA DR
Second Line :
City : OAKWOOD
State : OH
Zip : 45419-3542
Country : US
Telephone Number : 937-414-3922
Fax Number :
Provider Business Practice Location Address
First Line : 1545 MARSETTA DR
Second Line :
City : BEAVERCREEK
State : OH
Zip : 45432-2732
Country : US
Telephone Number : 937-373-3423
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2025
Last Update Date : 12/08/2025

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Directions to “ HEATHER LARAEL PETERS ” Practice Location

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