Healthcare Provider Details

I. General information

NPI: 1942370325
Provider Name (Legal Business Name): JODELLE L HEATH MS OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JODELLE L MARTIN MS OTR

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 08/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 PILLSBURY STREET SUITE 404
CONCORD NH
03301-3549
US

IV. Provider business mailing address

200 PAIGE HILL RD
GOFFSTOWN NH
03045
US

V. Phone/Fax

Practice location:
  • Phone: 603-228-7827
  • Fax: 603-228-7828
Mailing address:
  • Phone: 603-384-1004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1712
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: