Provider Demographics
NPI:1821397134
Name:MCLENNAN, HEIDI LYN (OT/L)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:LYN
Last Name:MCLENNAN
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 VERNEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03047
Mailing Address - Country:US
Mailing Address - Phone:603-547-3311
Mailing Address - Fax:603-547-6212
Practice Address - Street 1:1 VERNEY DRIVE
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:NH
Practice Address - Zip Code:03047
Practice Address - Country:US
Practice Address - Phone:603-547-3311
Practice Address - Fax:603-547-6212
Is Sole Proprietor?:No
Enumeration Date:2011-03-25
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119003385225X00000X
NHNHLICENSENO2260225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
496604OtherMEDICARE
VA4978803Medicaid