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General NPI Number Information
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NPI Number | 1558567198
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Entity Type | Individual
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Provider Name | HEATHER MICHELLE HENDERSON OTRL
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Gender | Female
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Dates
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Enumeration Date | 06/21/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1 SISKIN PLZ
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City | CHATTANOOGA
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State | TN
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Zip | 37403-1306
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Country | US
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Telephone | 423-634-1500
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Fax | 423-634-4578
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Provider Business Mailing Address
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Address Line | 3400 JENKINS RD APT 909
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City | CHATTANOOGA
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State | TN
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Zip | 37421-1152
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Country | US
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Telephone | 423-580-2057
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 0000003278
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License Number State | TN
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