Provider Demographics
NPI:1629372065
Name:HEYNS, DARICE MERLE
Entity Type:Individual
Prefix:
First Name:DARICE
Middle Name:MERLE
Last Name:HEYNS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3197 DUNCAN DR
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-1915
Mailing Address - Country:US
Mailing Address - Phone:503-675-0323
Mailing Address - Fax:
Practice Address - Street 1:3197 DUNCAN DR
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-1915
Practice Address - Country:US
Practice Address - Phone:503-675-0323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-28
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR996011225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist