Healthcare Provider Details

I. General information

NPI: 1740185867
Provider Name (Legal Business Name): HEATHER ILER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2931 MANLEY RD
MAUMEE OH
43537-9694
US

IV. Provider business mailing address

2931 MANLEY RD
MAUMEE OH
43537-9694
US

V. Phone/Fax

Practice location:
  • Phone: 419-917-8230
  • Fax:
Mailing address:
  • Phone: 419-917-8230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code136A00000X
TaxonomyRegistered Dietetic Technician
License Number964332
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: