Healthcare Provider Details

I. General information

NPI: 1013341783
Provider Name (Legal Business Name): HEIDI M EKLUND COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2013
Last Update Date: 08/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 PINECREST DR
EXETER RI
02822-3735
US

IV. Provider business mailing address

74 PINECREST DR
EXETER RI
02822-3735
US

V. Phone/Fax

Practice location:
  • Phone: 401-339-9677
  • Fax:
Mailing address:
  • Phone: 401-339-9677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA00665
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: