Provider Demographics
NPI:1619513413
Name:HEIDEN, KIRAH J (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:KIRAH
Middle Name:J
Last Name:HEIDEN
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-2264
Mailing Address - Country:US
Mailing Address - Phone:608-738-1489
Mailing Address - Fax:608-781-9580
Practice Address - Street 1:826 2ND AVE N
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-2208
Practice Address - Country:US
Practice Address - Phone:087-381-4896
Practice Address - Fax:608-781-9580
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11327225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist