Provider Demographics
NPI:1639319742
Name:SOUERS, HEATHER MARIE (CTRS)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:MARIE
Last Name:SOUERS
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 S PAPER BIRCH CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-4584
Mailing Address - Country:US
Mailing Address - Phone:812-606-5404
Mailing Address - Fax:
Practice Address - Street 1:1100 S PAPER BIRCH CT
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-4584
Practice Address - Country:US
Practice Address - Phone:812-606-5404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN55508225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist