Healthcare Provider Details

I. General information

NPI: 1558393181
Provider Name (Legal Business Name): HEIDI ANDERSON OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 S COWLEY ST
SPOKANE WA
99202-1330
US

IV. Provider business mailing address

711 S COWLEY ST
SPOKANE WA
99202-1330
US

V. Phone/Fax

Practice location:
  • Phone: 509-473-6000
  • Fax:
Mailing address:
  • Phone: 509-473-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT00003039
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: