Provider Demographics
NPI:1619129343
Name:FYFE, HEATHER
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:FYFE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:FYFE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR MA MOT
Mailing Address - Street 1:1400 PALM VALLEY DR W APT 8
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78552-9004
Mailing Address - Country:US
Mailing Address - Phone:956-970-5544
Mailing Address - Fax:
Practice Address - Street 1:1400 PALM VALLEY DR W APT 8
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78552-9004
Practice Address - Country:US
Practice Address - Phone:956-970-5544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-13
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109766225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist