Provider Demographics
NPI:1760675995
Name:WILDERMAN, HEIDY
Entity Type:Individual
Prefix:MRS
First Name:HEIDY
Middle Name:
Last Name:WILDERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 SAXON LN
Mailing Address - Street 2:
Mailing Address - City:MAPLE GLEN
Mailing Address - State:PA
Mailing Address - Zip Code:19002-3170
Mailing Address - Country:US
Mailing Address - Phone:215-657-6023
Mailing Address - Fax:
Practice Address - Street 1:1845 SAXON LN
Practice Address - Street 2:
Practice Address - City:MAPLE GLEN
Practice Address - State:PA
Practice Address - Zip Code:19002-3170
Practice Address - Country:US
Practice Address - Phone:215-657-6023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC000917L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist