Provider Demographics
NPI:1518012376
Name:HEUSLER, MARTICA LYN (OTR)
Entity Type:Individual
Prefix:MRS
First Name:MARTICA
Middle Name:LYN
Last Name:HEUSLER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 CYPRESS CT
Mailing Address - Street 2:
Mailing Address - City:MANAKIN SABOT
Mailing Address - State:VA
Mailing Address - Zip Code:23103-3154
Mailing Address - Country:US
Mailing Address - Phone:804-784-3806
Mailing Address - Fax:
Practice Address - Street 1:40 BROAD STREET RD
Practice Address - Street 2:
Practice Address - City:MANAKIN SABOT
Practice Address - State:VA
Practice Address - Zip Code:23103-2213
Practice Address - Country:US
Practice Address - Phone:804-784-3514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119002716225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist