Provider Demographics
NPI:1740402668
Name:HECKMAN, COLLEEN CHRISTINE (MS OTR L)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:CHRISTINE
Last Name:HECKMAN
Suffix:
Gender:F
Credentials:MS OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 YATES TERRACE
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19311
Mailing Address - Country:US
Mailing Address - Phone:610-256-8512
Mailing Address - Fax:
Practice Address - Street 1:306 YATES TERRACE
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:PA
Practice Address - Zip Code:19311
Practice Address - Country:US
Practice Address - Phone:610-256-8512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEU10000848174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist