Provider Demographics
NPI:1578950366
Name:FAHSL, HEATHER (ATC)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:
Last Name:FAHSL
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8310 116TH ST SE
Mailing Address - Street 2:
Mailing Address - City:CLEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55319-9623
Mailing Address - Country:US
Mailing Address - Phone:320-266-7887
Mailing Address - Fax:
Practice Address - Street 1:1901 CONNECTICUT AVE S
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-2554
Practice Address - Country:US
Practice Address - Phone:320-259-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN25982255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer