MEDICARE: HEATHER NICOLE HABERHERN OT

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3156797	OTHER	TN	BCBST - GROUP NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609822014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER NICOLE HABERHERN OT

Provider Business Mailing Address
First Line	:	8823 PRODUCTION LN
Second Line	:
City	:	OOLTEWAH
State	:	TN
Zip	:	37363-6511
Country	:	US
Telephone Number	:	423-238-7217
Fax Number	:	423-238-3473

Provider Business Practice Location Address
First Line	:	5022 OLD GODSEY LN
Second Line	:	SUITE 3
City	:	HIXSON
State	:	TN
Zip	:	37343-6600
Country	:	US
Telephone Number	:	423-870-3573
Fax Number	:	423-870-3574

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

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	01/27/2011

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