Provider Demographics
NPI:1376760561
Name:HEATH, BRETT JAMES (CDMS, CVE)
Entity Type:Individual
Prefix:MR
First Name:BRETT
Middle Name:JAMES
Last Name:HEATH
Suffix:
Gender:M
Credentials:CDMS, CVE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3073 MIRIMAR ST
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45409-1413
Mailing Address - Country:US
Mailing Address - Phone:937-299-4269
Mailing Address - Fax:937-643-0111
Practice Address - Street 1:5555 GLENDON CT
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-3249
Practice Address - Country:US
Practice Address - Phone:937-643-0846
Practice Address - Fax:937-643-0111
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00010608174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist