Provider Demographics
NPI:1144407206
Name:BRESNAHAN, HEIDI FRAIR (LMT)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:FRAIR
Last Name:BRESNAHAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 WINDING BROOK LN
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:ME
Mailing Address - Zip Code:04005-7343
Mailing Address - Country:US
Mailing Address - Phone:207-499-2180
Mailing Address - Fax:
Practice Address - Street 1:8 WINDING BROOK LN
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:ME
Practice Address - Zip Code:04005-7343
Practice Address - Country:US
Practice Address - Phone:207-499-2180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEME374256225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist