Healthcare Provider Details

I. General information

NPI: 1356640957
Provider Name (Legal Business Name): CARRIE A HEYWOOD LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2011
Last Update Date: 09/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 W 5TH AVE
COLUMBUS OH
43212-2404
US

IV. Provider business mailing address

1540 W 5TH AVE
COLUMBUS OH
43212-2404
US

V. Phone/Fax

Practice location:
  • Phone: 614-987-5956
  • Fax:
Mailing address:
  • Phone: 614-987-5956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number33.019309
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: