Healthcare Provider Details

I. General information

NPI: 1316921422
Provider Name (Legal Business Name): HEIDI GOWDEN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 COMMERCE BLVD SUITE 107
DICKSON CITY PA
18519-1677
US

IV. Provider business mailing address

851 COMMERCE BLVD SUITE 107
DICKSON CITY PA
18519-1677
US

V. Phone/Fax

Practice location:
  • Phone: 570-489-5561
  • Fax: 570-489-5563
Mailing address:
  • Phone: 570-489-5561
  • Fax: 570-489-5563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License NumberOC006456 L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC006456 L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code225XE1200X
TaxonomyErgonomics Occupational Therapist
License NumberOC006456 L
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOC006456 L
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOC006456 L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: