Healthcare Provider Details

I. General information

NPI: 1124954748
Provider Name (Legal Business Name): HEATHER HARTMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11413 UPPER GEORGES CREEK RD SW
FROSTBURG MD
21532-3702
US

IV. Provider business mailing address

11413 UPPER GEORGES CREEK RD SW
FROSTBURG MD
21532-3702
US

V. Phone/Fax

Practice location:
  • Phone: 301-338-1317
  • Fax:
Mailing address:
  • Phone: 301-338-1317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License NumberK8R133300187
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: