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General NPI Number Information
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NPI Number | 1649689852
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Entity Type | Individual
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Provider Name | HEATHER EDWARDS
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Gender | Female
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Dates
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Enumeration Date | 08/13/2014
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Last Update Date | 08/13/2014
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Provider Practice Location Address
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Address Line | 112 2ND ST
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City | MASON
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State | WV
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Zip | 25260
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Country | US
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Telephone | 740-416-1827
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Fax |
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Provider Business Mailing Address
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Address Line | 30877 NEECE RD
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City | MIDDLEPORT
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State | OH
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Zip | 45760-9747
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Country | US
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Telephone |
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 20010896
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License Number State | WV
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