Healthcare Provider Details

I. General information

NPI: 1477347755
Provider Name (Legal Business Name): BRYCE HEITMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2025
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 JULIANA ST
PARKERSBURG WV
26101-5352
US

IV. Provider business mailing address

1208 COUNTY HOUSE LN APT D
MARIETTA OH
45750-9571
US

V. Phone/Fax

Practice location:
  • Phone: 304-893-9777
  • Fax:
Mailing address:
  • Phone: 740-885-8530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: