Provider Demographics
NPI:1609822014
Name:HABERHERN, HEATHER NICOLE (OT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:NICOLE
Last Name:HABERHERN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:NICOLE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:5022 OLD GODSEY LN
Practice Address - Street 2:SUITE 3
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-6600
Practice Address - Country:US
Practice Address - Phone:423-870-3573
Practice Address - Fax:423-870-3574
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3156797OtherBCBST - GROUP NUMBER
TN0446652Medicaid
TN0446652Medicaid