Healthcare Provider Details

I. General information

NPI: 1770723389
Provider Name (Legal Business Name): HEIDI A FORBES OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2009
Last Update Date: 02/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 PROVIDENT DR
WARSAW IN
46580-3252
US

IV. Provider business mailing address

4026 WYANDOTTE DR
FORT WAYNE IN
46815-4853
US

V. Phone/Fax

Practice location:
  • Phone: 574-371-2500
  • Fax:
Mailing address:
  • Phone: 260-492-9605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number31005752A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: