Provider Demographics
NPI:1235753310
Name:HEBDA, NATHAN (OTR/L, C/NDT)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:HEBDA
Suffix:
Gender:M
Credentials:OTR/L, C/NDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 N SHORELINE DR
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-6615
Mailing Address - Country:US
Mailing Address - Phone:907-376-6363
Mailing Address - Fax:907-376-6366
Practice Address - Street 1:650 N SHORELINE DR
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-6615
Practice Address - Country:US
Practice Address - Phone:907-376-6363
Practice Address - Fax:907-376-6366
Is Sole Proprietor?:No
Enumeration Date:2020-06-03
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKPHYO2716225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand