Provider Demographics
NPI:1225321227
Name:SOUSSAN, HEIDI (MS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:
Last Name:SOUSSAN
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14742 HARTSOOK ST
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1407
Mailing Address - Country:US
Mailing Address - Phone:310-980-1812
Mailing Address - Fax:
Practice Address - Street 1:14742 HARTSOOK ST
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1407
Practice Address - Country:US
Practice Address - Phone:310-980-1812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT5913174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist