MEDICARE: MRS. HEIDI LYNN LARGA

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	TR4600277900	NJ

General Provider Information

NPI Number	:	1780899914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HEIDI LYNN LARGA

Provider Business Mailing Address
First Line	:	209 PEACHTREE VLG
Second Line	:
City	:	HACKETTSTOWN
State	:	NJ
Zip	:	07840-4518
Country	:	US
Telephone Number	:	908-852-4035
Fax Number	:

Provider Business Practice Location Address
First Line	:	415 SOUTHERN BLVD
Second Line	:
City	:	CHATHAM
State	:	NJ
Zip	:	07928-1488
Country	:	US
Telephone Number	:	973-822-8311
Fax Number	:

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

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	07/08/2007

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