Provider Demographics
NPI:1659430064
Name:SPANN, HEIDI DAWN
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:DAWN
Last Name:SPANN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:HEIDI
Other - Middle Name:DAWN
Other - Last Name:WALLACE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2530 E TARO LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050
Mailing Address - Country:US
Mailing Address - Phone:602-404-2711
Mailing Address - Fax:
Practice Address - Street 1:2530 E TARO LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050
Practice Address - Country:US
Practice Address - Phone:602-404-2711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5571225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist