Provider Demographics
NPI:1578857223
Name:BROHM, HEATHER YALDEN (OTR/L)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:YALDEN
Last Name:BROHM
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1666 HEMLOCK CIR
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-3543
Mailing Address - Country:US
Mailing Address - Phone:732-267-7842
Mailing Address - Fax:
Practice Address - Street 1:1666 HEMLOCK CIR
Practice Address - Street 2:
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-3543
Practice Address - Country:US
Practice Address - Phone:732-267-7842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-29
Last Update Date:2011-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC011081225X00000X
NJ46TR00501000225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist