Provider Demographics
NPI:1235456047
Name:NIPPERT, HEATH MUREL (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:HEATH
Middle Name:MUREL
Last Name:NIPPERT
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 PARK DR
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-3547
Mailing Address - Country:US
Mailing Address - Phone:575-749-1046
Mailing Address - Fax:
Practice Address - Street 1:1201 N NORRIS ST
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-6371
Practice Address - Country:US
Practice Address - Phone:575-749-1046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1910225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist