Provider Demographics
NPI:1689726432
Name:CRANDELL, HEATHER MARIE (OTR)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:CRANDELL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 PRAIRIE HEIGHTS DRIVE
Mailing Address - Street 2:APT 102
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593
Mailing Address - Country:US
Mailing Address - Phone:608-335-2985
Mailing Address - Fax:
Practice Address - Street 1:2620 WAUNONA WAY
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-1525
Practice Address - Country:US
Practice Address - Phone:608-223-1452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4409-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist