Healthcare Provider Details

I. General information

NPI: 1326336090
Provider Name (Legal Business Name): HEATHER WOOD REAM OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2011
Last Update Date: 07/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1454 WHIPKEY DAM RD
MARKLETON PA
15551-8140
US

IV. Provider business mailing address

1454 WHIPKEY DAM RD
MARKLETON PA
15551-8140
US

V. Phone/Fax

Practice location:
  • Phone: 814-926-2718
  • Fax:
Mailing address:
  • Phone: 814-926-2718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number1535
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number06698
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOC008471
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: