MEDICARE: TERESITA SEBASTIAN HECKLER OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	31002691A	IN

General Provider Information

NPI Number	:	1023226883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESITA SEBASTIAN HECKLER OTR

Provider Business Mailing Address
First Line	:	1325 E ERVIN RD
Second Line	:
City	:	VAN WERT
State	:	OH
Zip	:	45891-2627
Country	:	US
Telephone Number	:	419-238-0945
Fax Number	:	419-238-0945

Provider Business Practice Location Address
First Line	:	1325 E ERVIN RD
Second Line	:
City	:	VAN WERT
State	:	OH
Zip	:	45891-2627
Country	:	US
Telephone Number	:	419-238-0945
Fax Number	:	419-238-0945

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	07/09/2007

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