Healthcare Provider Details

I. General information

NPI: 1629497276
Provider Name (Legal Business Name): THERESA HEIBEL DVM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2014
Last Update Date: 04/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 STATE ROUTE 59
KENT OH
44240-7144
US

IV. Provider business mailing address

2222 STATE ROUTE 59
KENT OH
44240-7144
US

V. Phone/Fax

Practice location:
  • Phone: 330-678-2770
  • Fax:
Mailing address:
  • Phone: 330-678-2770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number7269
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: