Healthcare Provider Details

I. General information

NPI: 1790186088
Provider Name (Legal Business Name): MELISSA E HEFFNER MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2014
Last Update Date: 09/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 POMEROY RD APT 2
ATHENS OH
45701-9474
US

IV. Provider business mailing address

20 POMEROY RD APT 2
ATHENS OH
45701-9474
US

V. Phone/Fax

Practice location:
  • Phone: 509-948-1032
  • Fax:
Mailing address:
  • Phone: 509-948-1032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number10916
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: