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General NPI Number Information
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NPI Number | 1740701614
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Entity Type | Individual
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Provider Name | GAYLENE HEATON OT-SC
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Gender | Female
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Dates
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Enumeration Date | 06/30/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 502 COPPER ST STE 5
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City | HURLEY
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State | WI
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Zip | 54534-1386
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Country | US
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Telephone | 715-563-0092
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Fax |
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Provider Business Mailing Address
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Address Line | 14337N STATELINE RD
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City | HURLEY
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State | WI
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Zip | 54534
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Country | US
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Telephone | 715-360-1250
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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 | 246ZX2200X
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Taxonomy Name | Orthopedic Assistant
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License Number | 16-1140
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License Number State |
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Taxonomy #2
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 17-2770
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License Number State |
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