Healthcare Provider Details

I. General information

NPI: 1124599907
Provider Name (Legal Business Name): AMANDA D HEPPNER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2018
Last Update Date: 08/16/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2504 N 14TH RD
WORDEN MT
59088-2116
US

IV. Provider business mailing address

2504 N 14TH RD
WORDEN MT
59088-2116
US

V. Phone/Fax

Practice location:
  • Phone: 406-861-9825
  • Fax: 406-206-0064
Mailing address:
  • Phone: 406-861-9825
  • Fax: 406-206-0064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number158333
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number60914214
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: