Healthcare Provider Details

I. General information

NPI: 1639142045
Provider Name (Legal Business Name): KERRI SPENCE HEILMAN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 05/07/2022
Certification Date: 05/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1388 LANETOWN RD
CROZET VA
22932-2811
US

IV. Provider business mailing address

1388 LANETOWN RD
CROZET VA
22932-2811
US

V. Phone/Fax

Practice location:
  • Phone: 434-216-4825
  • Fax:
Mailing address:
  • Phone: 434-216-4825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119003052
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: