Provider Demographics
NPI:1073722872
Name:HEPBURN, DOUGLAS J (MS, ATC)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:J
Last Name:HEPBURN
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
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Mailing Address - Street 1:833 TOWNHOUSE LN
Mailing Address - Street 2:
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-3418
Mailing Address - Country:US
Mailing Address - Phone:314-920-1255
Mailing Address - Fax:314-909-0518
Practice Address - Street 1:333 S KIRKWOOD RD
Practice Address - Street 2:SUITE 201
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-6161
Practice Address - Country:US
Practice Address - Phone:314-909-0517
Practice Address - Fax:314-909-0518
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO20020238372255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer