Provider Demographics
NPI:1235225244
Name:HEATHER LITTLE
Entity Type:Organization
Organization Name:HEATHER LITTLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-641-1234
Mailing Address - Street 1:107 KILSON DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8162
Mailing Address - Country:US
Mailing Address - Phone:704-641-1234
Mailing Address - Fax:
Practice Address - Street 1:107 KILSON DR
Practice Address - Street 2:SUITE 106
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8162
Practice Address - Country:US
Practice Address - Phone:704-641-1234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies