MEDICARE: HEATHER LARAEL PETERS

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1356204291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER LARAEL PETERS

Provider Business Mailing Address
First Line	:	315 SPIREA DR
Second Line	:
City	:	OAKWOOD
State	:	OH
Zip	:	45419-3542
Country	:	US
Telephone Number	:	937-414-3922
Fax Number	:

Provider Business Practice Location Address
First Line	:	1545 MARSETTA DR
Second Line	:
City	:	BEAVERCREEK
State	:	OH
Zip	:	45432-2732
Country	:	US
Telephone Number	:	937-373-3423
Fax Number	:

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

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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Directions to “ HEATHER LARAEL PETERS ” Practice Location

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