Healthcare Provider Details

I. General information

NPI: 1982145421
Provider Name (Legal Business Name): HANNAH HERITAGE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2017
Last Update Date: 04/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 LINCOLN DR W
AMBLER PA
19002-3807
US

IV. Provider business mailing address

411 LINCOLN DR W
AMBLER PA
19002-3807
US

V. Phone/Fax

Practice location:
  • Phone: 215-840-7875
  • Fax:
Mailing address:
  • Phone: 215-840-7875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License NumberOC014787
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: