Healthcare Provider Details

I. General information

NPI: 1821382599
Provider Name (Legal Business Name): HEATHER MARIE L WYSTEPEK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2011
Last Update Date: 05/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 OLD LYMAN RD
SOUTH HADLEY MA
01075-2630
US

IV. Provider business mailing address

30 OLD LYMAN RD
SOUTH HADLEY MA
01075-2630
US

V. Phone/Fax

Practice location:
  • Phone: 413-533-7140
  • Fax:
Mailing address:
  • Phone: 413-533-7140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: