Provider Demographics
NPI:1780853598
Name:HEARD INNOVATIVE PEDIATRIC THERAPY, PLLC
Entity Type:Organization
Organization Name:HEARD INNOVATIVE PEDIATRIC THERAPY, PLLC
Other - Org Name:NONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:HEARD
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:480-241-7152
Mailing Address - Street 1:4700 E THOMAS RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-7700
Mailing Address - Country:US
Mailing Address - Phone:602-595-6683
Mailing Address - Fax:866-659-7750
Practice Address - Street 1:4700 E THOMAS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-7700
Practice Address - Country:US
Practice Address - Phone:602-595-6683
Practice Address - Fax:866-659-7750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3331225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1578699146OtherNPI
AZ080176OtherAHCCCS