Provider Demographics
NPI:1568979409
Name:MEDELLIN, HEATHER ASHLEY I
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ASHLEY
Last Name:MEDELLIN
Suffix:I
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 1:90 SARAH DR
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17315-1667
Mailing Address - Country:US
Mailing Address - Phone:717-329-4784
Mailing Address - Fax:
Practice Address - Street 1:100 MOUNT ALLEN DR
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-6171
Practice Address - Country:US
Practice Address - Phone:717-697-4666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-31
Last Update Date:2017-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP008706224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant