Provider Demographics
NPI:1083812549
Name:HEIDECKER, FAITH FERGUSON (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:FAITH
Middle Name:FERGUSON
Last Name:HEIDECKER
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 RUBY POINTE DR SE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603-5203
Mailing Address - Country:US
Mailing Address - Phone:256-355-3495
Mailing Address - Fax:
Practice Address - Street 1:7047 OLD MADISON PIKE NW
Practice Address - Street 2:SUITE 305
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-4500
Practice Address - Country:US
Practice Address - Phone:256-355-3495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2304225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist