Healthcare Provider Details

I. General information

NPI: 1235753310
Provider Name (Legal Business Name): NATHAN HEBDA OTR/L, C/NDT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2020
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 N SHORELINE DR
WASILLA AK
99654-6615
US

IV. Provider business mailing address

650 N SHORELINE DR
WASILLA AK
99654-6615
US

V. Phone/Fax

Practice location:
  • Phone: 907-376-6363
  • Fax: 907-376-6366
Mailing address:
  • Phone: 907-376-6363
  • Fax: 907-376-6366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberOT.0009069
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberPHYO2716
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: