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General NPI Number Information
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NPI Number | 1619513413
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Entity Type | Individual
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Provider Name | KIRAH J HEIDEN MASSAGE THERAPIST
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Gender | Female
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Dates
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Enumeration Date | 11/27/2019
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 826 2ND AVE N
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City | ONALASKA
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State | WI
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Zip | 54650-2208
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Country | US
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Telephone | 87-381-4896
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Fax | 608-781-9580
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Provider Business Mailing Address
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Address Line | 831 WEST AVE
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City | ONALASKA
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State | WI
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Zip | 54650-2264
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Country | US
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Telephone | 608-738-1489
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Fax | 608-781-9580
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 11327
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License Number State | WI
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