Provider Demographics
NPI:1740409317
Name:BLACKIE, HEIDI R (OTR/L, CHT)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:R
Last Name:BLACKIE
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 N 45TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-6907
Mailing Address - Country:US
Mailing Address - Phone:206-633-8100
Mailing Address - Fax:206-632-1420
Practice Address - Street 1:2409 N 45TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103
Practice Address - Country:US
Practice Address - Phone:206-633-8100
Practice Address - Fax:206-632-1420
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00003079225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2100419Medicaid