Provider Demographics
NPI:1275077604
Name:HEIDEL, HEATHER (ATC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:HEIDEL
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17099 COUNTY SEAT HWY
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19947-4865
Mailing Address - Country:US
Mailing Address - Phone:302-856-0961
Mailing Address - Fax:302-856-7882
Practice Address - Street 1:17099 COUNTY SEAT HWY
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947-4865
Practice Address - Country:US
Practice Address - Phone:302-856-0961
Practice Address - Fax:302-856-7882
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-04
Last Update Date:2016-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ3-00003572255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer