Healthcare Provider Details

I. General information

NPI: 1942130257
Provider Name (Legal Business Name): HEATHER ANNE HERALD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N BALL ST
OWOSSO MI
48867-2811
US

IV. Provider business mailing address

111 N BALL ST
OWOSSO MI
48867-2811
US

V. Phone/Fax

Practice location:
  • Phone: 989-494-1864
  • Fax:
Mailing address:
  • Phone: 989-494-1864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7501017642
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: