Healthcare Provider Details

I. General information

NPI: 1154607406
Provider Name (Legal Business Name): HEATHER DIANE DANZ OTA, PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER DANZ JONES OTA, PTA

II. Dates (important events)

Enumeration Date: 11/01/2011
Last Update Date: 06/28/2020
Certification Date: 06/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 NURSING HOME DR
CLAREMONT NH
03743-7344
US

IV. Provider business mailing address

1 MEDICAL CENTER DR
LEBANON NH
03756-1000
US

V. Phone/Fax

Practice location:
  • Phone: 603-542-9511
  • Fax:
Mailing address:
  • Phone: 603-650-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number0628
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1066
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: