Provider Demographics
NPI:1275987877
Name:ROBERTS, HEATHER JANE
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:JANE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 8TH ST UPPR
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:WA
Mailing Address - Zip Code:98826-1304
Mailing Address - Country:US
Mailing Address - Phone:206-276-0754
Mailing Address - Fax:
Practice Address - Street 1:833 FRONT ST
Practice Address - Street 2:SUITE 43
Practice Address - City:LEAVENWORTH
Practice Address - State:WA
Practice Address - Zip Code:98826-1378
Practice Address - Country:US
Practice Address - Phone:206-276-0754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60580382225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist