Provider Demographics
NPI:1821205790
Name:MASSEY, HEATHER JENALEE
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:JENALEE
Last Name:MASSEY
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 1:815 MORNINGSIDE DR
Mailing Address - Street 2:APT B-11
Mailing Address - City:KENTON
Mailing Address - State:OH
Mailing Address - Zip Code:43326-2611
Mailing Address - Country:US
Mailing Address - Phone:937-599-2766
Mailing Address - Fax:937-599-3151
Practice Address - Street 1:1600 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-1508
Practice Address - Country:US
Practice Address - Phone:937-599-2766
Practice Address - Fax:937-599-3151
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator