Provider Demographics
NPI:1477880268
Name:HORA, HEATHER ANN
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANN
Last Name:HORA
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 1:729 PINE MOUNTAIN VIEW ROAD
Mailing Address - Street 2:PO BOX 761
Mailing Address - City:VICTOR
Mailing Address - State:ID
Mailing Address - Zip Code:83455
Mailing Address - Country:US
Mailing Address - Phone:208-705-7868
Mailing Address - Fax:
Practice Address - Street 1:73 NORTH MAIN STREET
Practice Address - Street 2:SUITE 3
Practice Address - City:VICTOR
Practice Address - State:ID
Practice Address - Zip Code:83455
Practice Address - Country:US
Practice Address - Phone:208-705-7868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-16
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOT - 528225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist