Provider Demographics
NPI:1013005164
Name:FOERSTER-BACH, HEATHER (OT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:FOERSTER-BACH
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:BACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:10459 RALEIGH RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55129-4202
Mailing Address - Country:US
Mailing Address - Phone:928-607-4233
Mailing Address - Fax:928-607-4233
Practice Address - Street 1:10459 RALEIGH RD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55129-4202
Practice Address - Country:US
Practice Address - Phone:928-607-4233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0003320225X00000X
MN103683225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ813867OtherAHCCCS NUMBER