Healthcare Provider Details

I. General information

NPI: 1114502598
Provider Name (Legal Business Name): INTEGRATIVE WELLNESS SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2021
Last Update Date: 03/16/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7076 OAK HILL RD
LOUDON NH
03307-0808
US

IV. Provider business mailing address

7076 OAK HILL RD
LOUDON NH
03307-0808
US

V. Phone/Fax

Practice location:
  • Phone: 603-417-4847
  • Fax:
Mailing address:
  • Phone: 603-417-4847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: CHRISTINA L HEPPDING
Title or Position: OCCUPATIONAL THERAPIST
Credential: MS, OTR, CTP, CMHIMP
Phone: 603-417-4847