Provider Demographics
NPI:1386187151
Name:FLETCHER, HEIDI KATHLEEN (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:KATHLEEN
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:KATHLEEN
Other - Last Name:VLADYKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3335 LT MOSS RD
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-7222
Mailing Address - Country:US
Mailing Address - Phone:406-549-6413
Mailing Address - Fax:406-542-0143
Practice Address - Street 1:3335 LT MOSS RD
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-7222
Practice Address - Country:US
Practice Address - Phone:406-549-6413
Practice Address - Fax:406-542-0143
Is Sole Proprietor?:No
Enumeration Date:2016-11-28
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60637528225X00000X
MT9471225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT200011811Medicaid